Healthcare Provider Details

I. General information

NPI: 1306771605
Provider Name (Legal Business Name): SALLY DIANE DIGIROLAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 NW HILL ST STE 4
BEND OR
97703-2972
US

IV. Provider business mailing address

1432 NW HARTFORD AVE
BEND OR
97703-2450
US

V. Phone/Fax

Practice location:
  • Phone: 818-207-0569
  • Fax:
Mailing address:
  • Phone: 818-207-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberBAP-E-10268737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: