Provider Demographics
NPI:1528286671
Name:AMBROSE, SATYA (ND, LAC)
Entity type:Individual
Prefix:
First Name:SATYA
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15691 SE ROYER RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7742
Mailing Address - Country:US
Mailing Address - Phone:503-658-7715
Mailing Address - Fax:
Practice Address - Street 1:15691 SE ROYER RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97015-7742
Practice Address - Country:US
Practice Address - Phone:503-658-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR39600171100000X
OR0714175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath