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General NPI Number Information
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NPI Number | 1013442532
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Entity Type | Individual
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Provider Name | CLIFFORD SERETAN LMT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 8555 SW TUALATIN RD
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City | TUALATIN
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State | OR
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Zip | 97062-8614
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Country | US
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Telephone | 503-691-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 18903 TERRY AVE
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-7956
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Country | US
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Telephone | 503-598-2838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 20017
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License Number State | OR
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