Provider Demographics
NPI:1558895789
Name:CANGELOSO, LENORE (LAC, MSAOM)
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:
Last Name:CANGELOSO
Suffix:
Gender:F
Credentials:LAC, MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SE DIVISION ST STE 117
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1085
Mailing Address - Country:US
Mailing Address - Phone:732-995-4751
Mailing Address - Fax:
Practice Address - Street 1:1235 SE DIVISION STREET
Practice Address - Street 2:SUIE 117
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:732-995-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR179677171100000X
ORAC179677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist