Provider Demographics
NPI:1922774488
Name:ALTA NATURAL MEDICINE LLC
Entity Type:Organization
Organization Name:ALTA NATURAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZAKSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:907-202-9917
Mailing Address - Street 1:4921 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6336
Mailing Address - Country:US
Mailing Address - Phone:907-202-9917
Mailing Address - Fax:503-575-9229
Practice Address - Street 1:2102 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3009
Practice Address - Country:US
Practice Address - Phone:907-202-9917
Practice Address - Fax:503-575-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center