Provider Demographics
NPI:1609173509
Name:MASFERRER, ROBERTO (LAC, MACOM)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MASFERRER
Suffix:
Gender:M
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E BIRCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3043
Mailing Address - Country:US
Mailing Address - Phone:503-318-9490
Mailing Address - Fax:509-209-9094
Practice Address - Street 1:214 E BIRCH ST STE 4
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3043
Practice Address - Country:US
Practice Address - Phone:503-318-9490
Practice Address - Fax:509-209-9094
Is Sole Proprietor?:No
Enumeration Date:2011-02-12
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274496439OtherTIN