Individual
XOE JOY BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
2928 SE HAWTHORNE BLVD, PORTLAND, OR 97214-4147
(503) 504-2914
Mailing address
2928 SE HAWTHORNE BLVD, PORTLAND, OR 97214-4147
(503) 504-2914
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
BAP-E-10245493
OR
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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