Provider Demographics
NPI: | 1538681408 |
---|---|
Name: | GOLDEN RIBBON ACUPUNCTURE, LLC |
Entity Type: | Organization |
Organization Name: | GOLDEN RIBBON ACUPUNCTURE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/ACUPUNCTURIST |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | ARTHUR |
Authorized Official - Last Name: | VALENCIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LAC |
Authorized Official - Phone: | 503-839-5510 |
Mailing Address - Street 1: | 1490 NW 4TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | GRESHAM |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97030-5306 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-957-1916 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1217 NE BURNSIDE RD STE 701 |
Practice Address - Street 2: | |
Practice Address - City: | GRESHAM |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97030-5770 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-839-5510 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-07-12 |
Last Update Date: | 2017-07-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | AC183543 | 261QH0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |