Healthcare Provider Details

I. General information

NPI: 1467045211
Provider Name (Legal Business Name): SPROUTING NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NE LINDEN AVE STE 6
GRESHAM OR
97030-3956
US

IV. Provider business mailing address

PO BOX 2144
FAIRVIEW OR
97024-1817
US

V. Phone/Fax

Practice location:
  • Phone: 971-358-1246
  • Fax: 971-358-1247
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: VERENIS ESTRADA
Title or Position: OWNER
Credential:
Phone: 971-358-1246