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NPI Code Detail

MEDICARE: ANDREA MENDIVIL

MEDICARE:   ANDREA  MENDIVIL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist19676OR

General Provider Information

NPI Number : 1922341593
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA MENDIVIL
Provider Business Mailing Address
First Line : 2031 SE BELMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2812
Country : US
Telephone Number : 971-325-4234
Fax Number :
Provider Business Practice Location Address
First Line : 2031 SE BELMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2812
Country : US
Telephone Number : 971-325-4234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2013
Last Update Date : 09/04/2015

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Directions to “ ANDREA MENDIVIL ” Practice Location

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