Individual
MR. RICARDO M DEAUSTRIA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2701 NW VAUGHN ST STE 154, PORTLAND, OR 97210-5349
(503) 719-4326
Mailing address
2701 NW VAUGHN ST STE 154, PORTLAND, OR 97210-5349
(503) 719-4326
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
15490
OR
Other
Enumeration date
12/02/2008
Last updated
09/25/2013
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