Provider Demographics
NPI:1447572839
Name:BAZYUK, MARINA VLADIMIROVNA (ND)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:VLADIMIROVNA
Last Name:BAZYUK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 SE TAMANGO ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4689
Mailing Address - Country:US
Mailing Address - Phone:503-210-5489
Mailing Address - Fax:
Practice Address - Street 1:8375 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-770-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1722175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath