Provider Demographics
NPI:1316729536
Name:ALTAMIRANO, CHRISTINE LOUISE (RDN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LOUISE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 N ANCHOR WAY APT 243
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7574
Mailing Address - Country:US
Mailing Address - Phone:209-298-9713
Mailing Address - Fax:
Practice Address - Street 1:2525 NW LOVEJOY ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2864
Practice Address - Country:US
Practice Address - Phone:503-847-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10235411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered