Provider Demographics
NPI:1881847846
Name:GOLDSTEIN, ALEXIS LEIGH (LAC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LEIGH
Last Name:GOLDSTEIN
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 1:4804 N ALBINA AVE
Mailing Address - Street 2:#1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2657
Mailing Address - Country:US
Mailing Address - Phone:971-219-2394
Mailing Address - Fax:
Practice Address - Street 1:4804 N ALBINA AVE
Practice Address - Street 2:#1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2657
Practice Address - Country:US
Practice Address - Phone:971-219-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist