Provider Demographics
NPI:1568230225
Name:VASUDEVAN, RAMA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:RAMA
Middle Name:
Last Name:VASUDEVAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:RAMA
Other - Middle Name:
Other - Last Name:VENKATARAMANA RAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11294 NW MANTRA LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4893
Mailing Address - Country:US
Mailing Address - Phone:503-961-2854
Mailing Address - Fax:
Practice Address - Street 1:1975 NW 167TH PL STE 100-14
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4908
Practice Address - Country:US
Practice Address - Phone:971-435-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC217740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist