Provider Demographics
NPI:1407271687
Name:IIDA, PAULI (LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:PAULI
Middle Name:
Last Name:IIDA
Suffix:
Gender:
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446
Mailing Address - Country:US
Mailing Address - Phone:907-299-7005
Mailing Address - Fax:
Practice Address - Street 1:631 E 19TH AVE BLDG B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4304
Practice Address - Country:US
Practice Address - Phone:907-299-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKACUA142171100000X
ORAC217539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist