Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1041 | OR |
NPI | 1144318676 |
---|---|
Provider Name | Dr. Ana M Squellati |
First Address | Gresham, OR 97030-7226 |
Second Address | Gresham, OR 97030-7226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1041 | STATE LICENSE (01) | OR |