Individual
DR. ALISA MAIA ILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ND
Contact information
Practice address
4246 SE BELMONT ST STE 5, PORTLAND, OR 97215-1676
(503) 445-8114
Mailing address
PO BOX 1125, LAKE OSWEGO, OR 97035-0503
(503) 593-1210
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
OR
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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