Marya Deda Inc

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC00978 Issued in OR

Legal business name

MARYA DEDA INC

Doing business as

Acupuncture on Broadway

Practice address

2933 NE Broadway St
Portland, OR 97232-1760

Phone

(503) 282-2268

Fax

(503) 282-2863

NPI assigned

Jul 14, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marya E. Deda Barakat

Title

Lac, LMT

Phone

(503) 282-2268

Specialties & licenses 1

Addresses

Other names 1

• Acupuncture on Broadway Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1841420692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2933 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321760",
            "telephone_number": "503-282-2268",
            "fax_number": "503-282-2863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2933 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321760",
            "telephone_number": "503-282-2268",
            "fax_number": "503-282-2863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYA DEDA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-14",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "BARAKAT",
        "authorized_official_first_name": "MARYA",
        "authorized_official_middle_name": "E. DEDA",
        "authorized_official_title_or_position": "LAC, LMT",
        "authorized_official_telephone_number": "503-282-2268"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC00978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acupuncture on Broadway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Acupuncturist in Portland, OR
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• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.