Provider Demographics
NPI:1871827824
Name:PORTNAYA, MARIA (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PORTNAYA
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 1:1515 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
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60114166171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist