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General NPI Number Information
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NPI Number | 1699548321
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Entity Type | Individual
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Provider Name | CRISTAL DEL ANGEL MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 15455 NW GREENBRIER PKWY STE 250
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City | BEAVERTON
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State | OR
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Zip | 97006-8116
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Country | US
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Telephone | 971-248-0068
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Fax |
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Provider Business Mailing Address
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Address Line | 17493 SW TURNING LEAF DR
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City | BEAVERTON
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State | OR
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Zip | 97003-7566
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Country | US
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Telephone | 503-381-1856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | 24676
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License Number State | OR
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