Individual
MELISSA KS BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MACOM, LAC
Contact information
Practice address
833 SE MAIN ST STE 323, PORTLAND, OR 97214-3427
(503) 894-0064
Mailing address
3135 SE 89TH AVE, PORTLAND, OR 97266
(971) 226-3539
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC208634
OR
Other
Enumeration date
12/23/2022
Last updated
12/23/2022
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