Provider Demographics
NPI:1073103537
Name:GILES, RITA ANNETTE (MPH, RD, LD, CNSC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ANNETTE
Last Name:GILES
Suffix:
Gender:F
Credentials:MPH, RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 COMMERCIAL ST SE # 101-133
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4981
Mailing Address - Country:US
Mailing Address - Phone:209-765-3158
Mailing Address - Fax:
Practice Address - Street 1:2755 COMMERCIAL ST SE # 101-133
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4981
Practice Address - Country:US
Practice Address - Phone:209-765-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10165257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered