Healthcare Provider Details

I. General information

NPI: 1285168435
Provider Name (Legal Business Name): VALERIA RECH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST
PORTLAND OR
97210-2859
US

IV. Provider business mailing address

PO BOX 91
WILSONVILLE OR
97070-0091
US

V. Phone/Fax

Practice location:
  • Phone: 503-847-9952
  • Fax:
Mailing address:
  • Phone: 503-850-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10182145
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: