Individual
JUAN PABLO LACAYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5417 NE 25TH AVE, PORTLAND, OR 97211-6211
(503) 282-6710
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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