Individual
MARIAH TALICURAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3912 N MISSISSIPPI AVE, PORTLAND, OR 97227-1163
(971) 703-4347
Mailing address
1717 SW PARK AVE, 1023, PORTLAND, OR 97201-3267
(360) 607-9416
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21183
OR
Other
Enumeration date
08/15/2016
Last updated
08/15/2016
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