=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306771605
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY DIANE DIGIROLAMO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2026
-----------------------------------------------------
Last Update Date | 06/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 888 NW HILL ST STE 4
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97703-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-207-0569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1432 NW HARTFORD AVE
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97703-2450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-207-0569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246Z00000X
-----------------------------------------------------
Taxonomy Name | Other Specialist/Technologist
-----------------------------------------------------
License Number | BAP-E-10268737
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------