Provider Demographics
NPI:1275735839
Name:MALIONGAS, POLLY (DIPL OM, LAC)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:MALIONGAS
Suffix:
Gender:F
Credentials:DIPL OM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-1529
Mailing Address - Country:US
Mailing Address - Phone:503-734-6743
Mailing Address - Fax:
Practice Address - Street 1:419 CENTER ST # 203
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2211
Practice Address - Country:US
Practice Address - Phone:503-516-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORACO1078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist