Individual
JASON ALBERTO ARDILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5105 SE HAWTHORNE BLVD, PORTLAND, OR 97215-3301
(503) 308-1479
Mailing address
3819 SE FRANCIS ST, PORTLAND, OR 97202-3214
(415) 524-5248
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25004
OR
Other
Enumeration date
08/02/2019
Last updated
08/02/2019
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