Healthcare Provider Details

I. General information

NPI: 1598364689
Provider Name (Legal Business Name): ZEDNIA CAROLINA LINARES MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 NE JUNIPER AVE
GRESHAM OR
97030-2928
US

IV. Provider business mailing address

2455 NE JUNIPER AVE
GRESHAM OR
97030-2928
US

V. Phone/Fax

Practice location:
  • Phone: 503-756-4191
  • Fax:
Mailing address:
  • Phone: 503-756-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10210635
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: