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General NPI Number Information
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NPI Number | 1891672903
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Entity Type | Organization
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Legal Business Name | THE REWILDING PRACTICE LLC
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 7886 SE 13TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-6300
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Country | US
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Telephone | 503-956-9396
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 86245
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City | PORTLAND
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State | OR
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Zip | 97286-0245
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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 | OWNER
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Name | DIANE MONTENEGRO
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Credential |
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Telephone | 909-945-7756
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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 |
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License Number State |
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