Individual
VITALY STARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Credential
LIC. TATTOO ARTIST
Contact information
Practice address
1614 NE ALBERTA ST, PORTLAND, OR 97211-5048
(503) 453-4557
Mailing address
1614 NE ALBERTA ST, PORTLAND, OR 97211-5048
(503) 453-4557
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
10153107
OR
Other
Enumeration date
10/03/2024
Last updated
10/08/2024
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