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General NPI Number Information
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NPI Number | 1831964477
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Entity Type | Individual
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Provider Name | LESLIE PHU ND, LAC
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Gender | Female
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Dates
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Enumeration Date | 11/22/2023
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 5440 SW WESTGATE DR STE 320
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City | PORTLAND
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State | OR
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Zip | 97221-2447
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Country | US
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Telephone | 503-847-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 60755 NW COCHRAN RD
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City | TIMBER
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State | OR
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Zip | 97144-9255
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC218113
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 5036
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License Number State | OR
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