Doctor Name: | CAROLE L MATIACO |
NPI Number: | 1700149580 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, LD |
License Number: | 000965 |
Business Practice Address: | 15895 Sw 72nd Ave Suite 250 Bldg B Tigard, OR - 972247977 |
Business Phone Number: | 5036245630 |
Business Fax Number: | 5036249149 |
Mailing Address: | 15895 Sw 72nd Ave, Suite 250 TIGARD |
State: | OR |
Postal Code: | 972247977 |
Phone Number: | 5036245630 |
Fax Number: | 5036249149 |
NPI Enumeration Date: | 06/18/2012 |
NPI Last Update Date: | 03/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 000965 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |