Provider Demographics
NPI:1508868522
Name:LUTSKOVSKY, VICTORIA (ND)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LUTSKOVSKY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LUTSKOVSKY - HASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:245 SE 4TH AVE
Mailing Address - Street 2:SUITE #E
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4033
Mailing Address - Country:US
Mailing Address - Phone:503-844-6667
Mailing Address - Fax:
Practice Address - Street 1:245 SE 4TH AVE
Practice Address - Street 2:SUITE #E
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4033
Practice Address - Country:US
Practice Address - Phone:503-844-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR985175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182953Medicaid
112837OtherKEIZER
112837OtherKEIZER