Provider Demographics
NPI:1356010029
Name:TRIMAS, MANDI (LAC)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:TRIMAS
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 1:9600 SW OAK ST STE 410
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6581
Mailing Address - Country:US
Mailing Address - Phone:503-575-9740
Mailing Address - Fax:
Practice Address - Street 1:9600 SW OAK ST STE 410
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6581
Practice Address - Country:US
Practice Address - Phone:503-575-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC199307171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist