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General NPI Number Information
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NPI Number | 1053287128
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Entity Type | Organization
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Legal Business Name | LOLO'S KITCHEN LLC
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 6735 SW COUNTRY CLUB DR
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City | CORVALLIS
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State | OR
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Zip | 97333-1987
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Country | US
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Telephone | 503-535-9703
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Fax | 971-484-1958
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE N
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 503-535-9703
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Fax | 971-484-1958
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Authorized Official
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Title or Position | EMPLOYEE
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Name | LAUREN TOBEY
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Credential | MS, RD, LD
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Telephone | 503-535-9703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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