Provider Demographics
NPI:1437031507
Name:BRIDGE CITY ELECTROLOGY AND AESTHETICS
Entity type:Organization
Organization Name:BRIDGE CITY ELECTROLOGY AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELECTROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:DELAROSE
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LE
Authorized Official - Phone:256-929-8845
Mailing Address - Street 1:5057 SE REEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6154
Mailing Address - Country:US
Mailing Address - Phone:256-929-8845
Mailing Address - Fax:
Practice Address - Street 1:2031 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2812
Practice Address - Country:US
Practice Address - Phone:503-894-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty