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General NPI Number Information
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NPI Number | 1760736474
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Entity Type | Organization
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Legal Business Name | JESSICA TATIEZE ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 5501 NE 109TH CT SUITE L
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City | VANCOUVER
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State | WA
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Zip | 98662-6177
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Country | US
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Telephone | 503-683-2138
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Fax | 360-891-8000
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Provider Business Mailing Address
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Address Line | 5501 NE 109TH CT SUITE L
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City | VANCOUVER
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State | WA
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Zip | 98662-6177
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Country | US
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Telephone | 503-683-2138
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Fax | 360-891-8000
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | JESSICA TATIEZE TEMGOUA
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Credential | LAC
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Telephone | 503-683-2138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC60197016
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License Number State | WA
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