Healthcare Provider Details

I. General information

NPI: 1578819520
Provider Name (Legal Business Name): JOSEPHINE DELA CRUZ TORRESANI R.D.,L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 THOMPSON RD
COOS BAY OR
97420-2125
US

IV. Provider business mailing address

1775 THOMPSON RD
COOS BAY OR
97420-2125
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-8183
  • Fax: 541-266-7829
Mailing address:
  • Phone: 541-269-8183
  • Fax: 541-266-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-001043
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: