Individual provider · NPI-1

Jaymi Costanzo

Acupuncturist · Gresham, OR

NPI number1447853213
StatusActive
Last updated in NPPESNov 16, 2020

Details

NPI
1447853213
Entity type
Individual (NPI-1)
Name
Jaymi Costanzo
Sex
Female
Sole proprietor
No
Enumeration date
Nov 16, 2020
Certification date
Nov 16, 2020
Last updated
Nov 16, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171100000X AcupuncturistAC201895ORYes

Practice location

1217 Ne Burnside Rd Ste 301
Gresham, OR 97030-5705

Phone 503-492-2625

Mailing address

1217 Ne Burnside Rd Ste 301
Gresham, OR 97030-5705

Phone 503-492-2625

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