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General NPI Number Information
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NPI Number | 1467045211
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Entity Type | Organization
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Legal Business Name | SPROUTING NUTRITION, LLC
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Dates
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Enumeration Date | 02/12/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 1300 NE LINDEN AVE STE 6
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City | GRESHAM
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State | OR
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Zip | 97030-3956
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Country | US
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Telephone | 971-358-1246
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Fax | 971-358-1247
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Provider Business Mailing Address
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Address Line | PO BOX 2144
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City | FAIRVIEW
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State | OR
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Zip | 97024-1817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERENIS ESTRADA
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Credential |
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Telephone | 971-358-1246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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