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General NPI Number Information
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NPI Number | 1104766385
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Entity Type | Organization
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Legal Business Name | PRISMATIC LLC
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 239 NE LINCOLN ST
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City | HILLSBORO
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State | OR
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Zip | 97124-3066
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Country | US
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Telephone | 503-359-4038
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Fax |
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Provider Business Mailing Address
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Address Line | 239 NE LINCOLN ST
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City | HILLSBORO
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State | OR
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Zip | 97124-3066
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Country | US
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Telephone | 503-359-4038
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISSA MARTIN
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Credential | LE
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Telephone | 503-359-4038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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