Individual
CAROLE L MATIACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
15895 SW 72ND AVE, SUITE 250 BLDG B, TIGARD, OR 97224-7977
(503) 624-5630
(503) 624-9149
Mailing address
15895 SW 72ND AVE, SUITE 250, TIGARD, OR 97224-7977
(503) 624-5630
(503) 624-9149
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000965
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5000662380
—
OR
Enumeration date
06/18/2012
Last updated
03/27/2015
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