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General NPI Number Information
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NPI Number | 1487560108
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Entity Type | Organization
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Legal Business Name | PACIFIC NUTRITION COLLECTIVE LLC
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 4605 NE FREMONT ST STE 210B
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City | PORTLAND
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State | OR
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Zip | 97213-1707
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Country | US
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Telephone | 503-482-2170
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Fax |
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Provider Business Mailing Address
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Address Line | 3519 NE 15TH AVE UNIT 707
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City | PORTLAND
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State | OR
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Zip | 97212-2356
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Country | US
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Telephone | 503-482-2170
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Fax |
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Authorized Official
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Title or Position | OWNER, DIETITIAN
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Name | DULCINEA CHILDS
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Credential | RD, MSN
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Telephone | 503-396-8854
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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 |
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License Number State |
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