=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033827407
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARICRUZ ARIAS-VILLANUEVA DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2022
-----------------------------------------------------
Last Update Date | 06/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4630 RIVER RD N STE A
-----------------------------------------------------
City | KEIZER
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97303-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-304-2225
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 KIRKSEY ST APT H204
-----------------------------------------------------
City | WOODBURN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97071-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-317-6548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6260
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------