Provider Demographics
NPI:1457113599
Name:AVALOS, RAUL GARCIA (LMT)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:GARCIA
Last Name:AVALOS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NE BRIARCREEK WAY APT 927
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8844
Mailing Address - Country:US
Mailing Address - Phone:564-444-0740
Mailing Address - Fax:
Practice Address - Street 1:1015 NE BRIARCREEK WAY APT 927
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8844
Practice Address - Country:US
Practice Address - Phone:564-444-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-28057225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist