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General NPI Number Information
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NPI Number | 1598394280
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Entity Type | Organization
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Legal Business Name | PORTLAND ELECTROLYSIS AND SKIN CARE
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 04/04/2020
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Provider Practice Location Address
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Address Line | 1017 SW MORRISON ST STE 400
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City | PORTLAND
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State | OR
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Zip | 97205-2629
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Country | US
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Telephone | 503-224-3300
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Fax | 503-224-3300
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Provider Business Mailing Address
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Address Line | 8110 SW LAUREL ST
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City | PORTLAND
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State | OR
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Zip | 97225-2324
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Country | US
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Telephone | 503-939-9370
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAIMEE T BLOOM
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Credential | LE
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Telephone | 503-939-9370
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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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