Provider Demographics
NPI:1598394280
Name:PORTLAND ELECTROLYSIS AND SKIN CARE
Entity Type:Organization
Organization Name:PORTLAND ELECTROLYSIS AND SKIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIMEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:LE
Authorized Official - Phone:503-939-9370
Mailing Address - Street 1:8110 SW LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-2324
Mailing Address - Country:US
Mailing Address - Phone:503-939-9370
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2629
Practice Address - Country:US
Practice Address - Phone:503-224-3300
Practice Address - Fax:503-224-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty