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General NPI Number Information
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NPI Number | 1912632266
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Entity Type | Organization
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Legal Business Name | BALANCED NUTRITION NW LLC
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 20369 HOMESTEAD DR
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City | OREGON CITY
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State | OR
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Zip | 97045-9012
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Country | US
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Telephone | 971-419-8549
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Fax | 971-229-4024
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Provider Business Mailing Address
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Address Line | 20369 HOMESTEAD DR
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City | OREGON CITY
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State | OR
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Zip | 97045-9012
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Country | US
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Telephone | 971-419-8549
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Fax | 971-229-4024
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Authorized Official
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Title or Position | REGISTERED DIETITIAN/CO-OWNER
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Name | VICTORIA PADRON
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Credential | RD
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Telephone | 971-419-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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