Provider Demographics
NPI:1972728798
Name:MESSINA-AZEKRI, MARIO ANDRES (LMT)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ANDRES
Last Name:MESSINA-AZEKRI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:MESSINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:RHODODENDRON
Mailing Address - State:OR
Mailing Address - Zip Code:97049-0236
Mailing Address - Country:US
Mailing Address - Phone:503-622-6029
Mailing Address - Fax:
Practice Address - Street 1:811 NW 19TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1401
Practice Address - Country:US
Practice Address - Phone:503-228-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5735225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist