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General NPI Number Information
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NPI Number | 1437031507
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Entity Type | Organization
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Legal Business Name | BRIDGE CITY ELECTROLOGY AND AESTHETICS
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 2031 SE BELMONT ST
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City | PORTLAND
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State | OR
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Zip | 97214-2812
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Country | US
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Telephone | 503-894-6134
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Fax |
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Provider Business Mailing Address
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Address Line | 5057 SE REEDWAY ST
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City | PORTLAND
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State | OR
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Zip | 97206-6154
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Country | US
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Telephone | 256-929-8845
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Fax |
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Authorized Official
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Title or Position | ELECTROLOGIST
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Name | RAYNA DELAROSE BOLTON
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Credential | LE
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Telephone | 256-929-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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