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Organization
ELEVEN ELEVEN, LLC
Active
Organization
ELEVEN ELEVEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIK BERNTSEN (OWNER)
(503) 956-9773
Entity
Organization
Contact information
Practice address
6714 SW 62ND PLACE, PORTLAND, OR 97219
(503) 956-9773
Mailing address
6714 SW 62ND PLACE, PORTLAND, OR 97219
(503) 956-9773
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
BAP-TA-10133461
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
155097
CERTIFIED PERMANENT COSMETICS PROFESSIONAL
OR
Enumeration date
12/01/2014
Last updated
12/01/2014
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