Individual
KYRA MARSICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7504 SE 105TH AVE, PORTLAND, OR 97266-6059
(714) 421-7699
Mailing address
7504 SE 105TH AVE, PORTLAND, OR 97266-6059
(714) 421-7699
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A749274
—
CA
Enumeration date
02/20/2023
Last updated
02/20/2023
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