1316729536 NPI number — CHRISTINE LOUISE ALTAMIRANO RDN

Table of content: CHRISTINE LOUISE ALTAMIRANO RDN (NPI 1316729536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316729536 NPI number — CHRISTINE LOUISE ALTAMIRANO RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTAMIRANO
Provider First Name:
CHRISTINE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLEN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316729536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 N ANCHOR WAY APT 243
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:
97217-7574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-298-9713
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 NW LOVEJOY ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210-2864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-847-9952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2023

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:  LD-D-10235411 , 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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