Provider Demographics
NPI:1659883247
Name:AGELESS ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:AGELESS ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTNAYA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:206-903-1888
Mailing Address - Street 1:1515 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1523
Mailing Address - Country:US
Mailing Address - Phone:206-903-1888
Mailing Address - Fax:206-903-1893
Practice Address - Street 1:1515 1ST AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1523
Practice Address - Country:US
Practice Address - Phone:206-903-1888
Practice Address - Fax:206-903-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60114166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty