Individual
ALICE FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CLT-LANA
Contact information
Practice address
4715 NE 14TH AVE, PORTLAND, OR 97211-5011
(503) 284-1033
Mailing address
4715 NE 14TH AVE, PORTLAND, OR 97211-5011
(503) 284-1033
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4828
OR
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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