Provider Demographics
NPI:1902641962
Name:KOCKLER, ANGELA M (RD, MBA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:KOCKLER
Suffix:
Gender:F
Credentials:RD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 SE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3209
Mailing Address - Country:US
Mailing Address - Phone:415-350-0706
Mailing Address - Fax:
Practice Address - Street 1:1915 SE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3209
Practice Address - Country:US
Practice Address - Phone:415-350-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered