| NPI | 1447834064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENNAYA LYNN MATTISON Owner 503-400-3434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-03-07 |