Provider Demographics
NPI:1689825457
Name:FERRUZZA, FELICIA (LAC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:FERRUZZA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 NE ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5003
Mailing Address - Country:US
Mailing Address - Phone:503-206-5309
Mailing Address - Fax:503-914-0459
Practice Address - Street 1:1223 NE ALBERTA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5003
Practice Address - Country:US
Practice Address - Phone:503-206-5309
Practice Address - Fax:503-914-0459
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01094171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500679562Medicaid