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General NPI Number Information
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NPI Number | 1336544725
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Entity Type | Organization
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Legal Business Name | TIFFANY'S APOTHEKE, LLC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 1983 NW FLANDERS ST SUITE 109
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City | PORTLAND
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State | OR
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Zip | 97209
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Country | US
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Telephone | 503-705-5738
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Fax |
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Provider Business Mailing Address
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Address Line | 7333 SE WOODWARD ST
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City | PORTLAND
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State | OR
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Zip | 97206
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Country | US
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Telephone | 503-705-5738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY D PRADO
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Credential | L.AC.
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Telephone | 503-705-5738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC156830
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License Number State | OR
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