Provider Demographics
NPI:1063867331
Name:WASHIZU, MAYA KATHLEEN (LAC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:KATHLEEN
Last Name:WASHIZU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 N. PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404
Mailing Address - Country:US
Mailing Address - Phone:707-280-7606
Mailing Address - Fax:541-919-0120
Practice Address - Street 1:474 WILLAMETTE ST. SUITE 303
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:707-280-7606
Practice Address - Fax:541-919-0120
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC175171100000X
ORAC175173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist