Provider Demographics
NPI:1720111206
Name:POLICANO, ARIEL ROSE
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:ROSE
Last Name:POLICANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8047 SW LANDAU ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8893
Mailing Address - Country:US
Mailing Address - Phone:503-892-0500
Mailing Address - Fax:
Practice Address - Street 1:8047 SW LANDAU ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8893
Practice Address - Country:US
Practice Address - Phone:503-892-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath