Provider Demographics
NPI:1891954541
Name:A RENAISSANCE HEALTH CENTER FOR NATURAL MEDICINE
Entity Type:Organization
Organization Name:A RENAISSANCE HEALTH CENTER FOR NATURAL MEDICINE
Other - Org Name:DR. ANA SQUELLATI
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER OF CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SQUELLATI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-665-2344
Mailing Address - Street 1:130 NW MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7226
Mailing Address - Country:US
Mailing Address - Phone:503-665-2344
Mailing Address - Fax:503-665-2337
Practice Address - Street 1:130 NW MILLER AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7226
Practice Address - Country:US
Practice Address - Phone:503-665-2344
Practice Address - Fax:503-665-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1041175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty