Individual
AZZAYA GANTULGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2149 NE BROADWAY ST, PORTLAND, OR 97232-1580
(503) 281-0278
Mailing address
2149 NE BROADWAY ST, PORTLAND, OR 97232-1580
(503) 281-0278
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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