Individual
MICCA DAVID HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN
Contact information
Practice address
8495 CRATER LAKE HWY, MAIL STOP: 120, WHITE CITY, OR 97503
(541) 826-2111
Mailing address
8495 CRATER LAKE HWY, MAIL STOP: 120, WHITE CITY, OR 97503
(541) 826-2111
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
12/06/2023
Last updated
12/06/2023
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