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Organization
PEACH SKIN NORTH PORTLAND HEALTHCARE LLC
Active
Organization
PEACH SKIN NORTH PORTLAND HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAQUELINE LOPES BROCKERT ND (MANAGER/EMPLOYEE)
(971) 413-3207
Entity
Organization
Contact information
Practice address
3537 N WILLIAMS AVE, PORTLAND, OR 97227-1437
(971) 413-3207
(503) 477-8107
Mailing address
3537 N WILLIAMS AVE, PORTLAND, OR 97227-1437
(971) 413-3207
(503) 477-8107
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
—
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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