MEDICARE: SARAH E SALTZBERG RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD-D-10152676	OR

General Provider Information

NPI Number	:	1922322510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH E SALTZBERG RD

Provider Business Mailing Address
First Line	:	1040 NW 22ND AVE STE 520
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3097
Country	:	US
Telephone Number	:	503-413-8136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 NW 22ND AVE STE 520
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3097
Country	:	US
Telephone Number	:	503-413-8136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	01/23/2015

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Directions to “ SARAH E SALTZBERG RD” Practice Location

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