Provider Demographics
NPI:1093442790
Name:MOONLIGHT THERAPIES LLC
Entity Type:Organization
Organization Name:MOONLIGHT THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAYELY
Authorized Official - Middle Name:DEL ROCIO
Authorized Official - Last Name:TRUJEQUE SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:971-772-8322
Mailing Address - Street 1:205 SE SPOKANE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6487
Mailing Address - Country:US
Mailing Address - Phone:971-772-8322
Mailing Address - Fax:971-275-1801
Practice Address - Street 1:205 SE SPOKANE ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6487
Practice Address - Country:US
Practice Address - Phone:971-772-8322
Practice Address - Fax:971-275-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty