Basic Information
| Provider Information | |||||||||
| NPI: | 1609384163 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LISA TONGEL ACUPUNCTURE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 NW VAUGHN ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972105352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035773669 | ||||||||
| FaxNumber: | 5034777673 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 NW VAUGHN ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972105352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032274050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2018 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | TONGEL | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | KAREN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5035773669 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | L.AC. | ||||||||
| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.