Provider Demographics
NPI:1306399761
Name:GARCIA, MICHELLE (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3886 BEVERLY AVE NE STE 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1373
Mailing Address - Country:US
Mailing Address - Phone:503-391-7872
Mailing Address - Fax:
Practice Address - Street 1:3886 BEVERLY AVE NE STE 6
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1373
Practice Address - Country:US
Practice Address - Phone:503-391-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL999631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered