Provider Demographics
NPI:1598835423
Name:POLECASTRO, ALONA ELIZABETH (LAC RDA)
Entity type:Individual
Prefix:
First Name:ALONA
Middle Name:ELIZABETH
Last Name:POLECASTRO
Suffix:
Gender:F
Credentials:LAC RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 NE 62ND AVE L6
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:503-891-4372
Mailing Address - Fax:
Practice Address - Street 1:4512 SE WOODSTOCK
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:503-891-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00548171100000X
WAD160053714126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No126800000XDental ProvidersDental Assistant