Provider Demographics
NPI:1073912556
Name:LOARCA VELASQUEZ, EMILY TUNSTALL (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:TUNSTALL
Last Name:LOARCA VELASQUEZ
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:TUNSTALL-FRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:4805 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2933
Mailing Address - Country:US
Mailing Address - Phone:971-358-9431
Mailing Address - Fax:
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:971-358-9431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
ORD-10172757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered