Provider Demographics
NPI:1770925620
Name:GINA ALBANESE
Entity type:Organization
Organization Name:GINA ALBANESE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED AUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ALBANESE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-358-7454
Mailing Address - Street 1:PO BOX 68056
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97268-0056
Mailing Address - Country:US
Mailing Address - Phone:503-358-7454
Mailing Address - Fax:
Practice Address - Street 1:9828 E BURNSIDE ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2365
Practice Address - Country:US
Practice Address - Phone:503-358-7454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC000641171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty