1821327305 NPI number — TRACY YVONNE ZEITZ RD, LD, CLT

Table of content: TRACY YVONNE ZEITZ RD, LD, CLT (NPI 1821327305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821327305 NPI number — TRACY YVONNE ZEITZ RD, LD, CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEITZ
Provider First Name:
TRACY
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821327305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7721 SE CESAR E CHAVEZ BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97202-8006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-810-6120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1235 SE DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97202-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-810-6120
Provider Business Practice Location Address Fax Number:
503-828-9812
Provider Enumeration Date:
12/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  00966332 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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