| Cultivating A New Life Llc | |
|
205 Se Spokane St Ste 300 Portland OR 97202-6487 | |
| (541) 904-0468 | |
| Not Available |
| Full Name | Cultivating A New Life Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 205 Se Spokane St Ste 300, Portland, Oregon |
| Authorized Official Name and Position | Fumiyo Nishimoto (OWNER) |
| Authorized Official Contact | 5419040468 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cultivating A New Life Llc 205 Se Spokane St Ste 300 Portland OR 97202-6487 Ph: (541) 904-0468 | Cultivating A New Life Llc 205 Se Spokane St Ste 300 Portland OR 97202-6487 Ph: (541) 904-0468 |
| NPI Number | 1003406505 |
|---|---|
| Provider Enumeration Date | 01/19/2021 |
| Last Update Date | 01/19/2021 |
| Certification Date | 01/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003406505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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