Provider Demographics
NPI:1083743496
Name:KOACH, ROSETTA (LMT, ND)
Entity Type:Individual
Prefix:DR
First Name:ROSETTA
Middle Name:
Last Name:KOACH
Suffix:
Gender:F
Credentials:LMT, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22235 SW FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8465
Mailing Address - Country:US
Mailing Address - Phone:503-628-6357
Mailing Address - Fax:503-521-1207
Practice Address - Street 1:22235 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8465
Practice Address - Country:US
Practice Address - Phone:503-628-6357
Practice Address - Fax:503-521-1207
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR978175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath