Provider Demographics
NPI:1134468374
Name:SCAMARONE, ALEXANDRA (LAC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SCAMARONE
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 1:15630 BOONES FERRY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3455
Mailing Address - Country:US
Mailing Address - Phone:503-862-3649
Mailing Address - Fax:
Practice Address - Street 1:15630 BOONES FERRY RD STE 6
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3455
Practice Address - Country:US
Practice Address - Phone:503-862-3649
Practice Address - Fax:503-974-0944
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC161756171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist