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General NPI Number Information
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NPI Number | 1386097541
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Entity Type | Individual
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Provider Name | RAQUEL ROSE R.D.N.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 2029 SE JEFFERSON ST STE 103
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City | MILWAUKIE
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State | OR
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Zip | 97222-7605
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Country | US
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Telephone | 503-825-0075
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 LAFAYETTE AVE
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City | OREGON CITY
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State | OR
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Zip | 97045-3814
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Country | US
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Telephone | 503-616-0281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86020670
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 10187067
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License Number State | OR
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