Provider Demographics
NPI:1629816574
Name:CAMPUZANO, LUZ MARIA (LMT)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:CAMPUZANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41831 SW LASALLE RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:OR
Mailing Address - Zip Code:97119-8636
Mailing Address - Country:US
Mailing Address - Phone:971-732-4457
Mailing Address - Fax:
Practice Address - Street 1:18879 SW TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2833
Practice Address - Country:US
Practice Address - Phone:503-430-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA.61181051225700000X
OR17799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist