Individual
MONICA FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 NE DEKUM ST, PORTLAND, OR 97211-2926
(503) 901-0960
Mailing address
820 SE 70TH AVE, PORTLAND, OR 97215-2129
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24226
OR
Other
Enumeration date
01/12/2019
Last updated
01/12/2019
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