Organization
BLUE STAR HEALING ARTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONA MYNNEL TARA M.D. (OWNER)
(541) 244-2292
Entity
Organization
Contact information
Practice address
714 NW 5TH ST, GRANTS PASS, OR 97526-1529
(541) 244-1511
(541) 244-1512
Mailing address
714 NW 5TH ST, GRANTS PASS, OR 97526-1529
(541) 244-1511
(541) 244-1512
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
MD15235
OR
Other
Enumeration date
12/01/2010
Last updated
12/12/2013
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