Individual
LACEY RAYE ORTIZ LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
340 NW 5TH ST, REDMOND, OR 97756-1869
(541) 516-4099
Mailing address
340 NW 5TH ST, REDMOND, OR 97756-1869
(541) 516-4099
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24-CRM-3553
OR
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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