Provider Demographics
NPI:1194099481
Name:LOMBARDI, DANIELLE LARA (LAC, MAOM)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LARA
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 N BEECH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1129
Mailing Address - Country:US
Mailing Address - Phone:971-340-0611
Mailing Address - Fax:
Practice Address - Street 1:1031 N BEECH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1129
Practice Address - Country:US
Practice Address - Phone:971-340-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC157101171100000X
OR171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist