Provider Demographics
NPI:1629110499
Name:DONGVILLO, OLGA SMITH (LICENSED ACUPUNCTURI)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:SMITH
Last Name:DONGVILLO
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E. 1ST AVE.
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-9435
Mailing Address - Country:US
Mailing Address - Phone:503-630-6555
Mailing Address - Fax:503-630-2838
Practice Address - Street 1:165 E. 1ST AVE.
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023-9435
Practice Address - Country:US
Practice Address - Phone:503-630-6555
Practice Address - Fax:503-630-2838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00204171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist