Provider Demographics
NPI:1316377484
Name:AMORA PICCOLO, CANDIACE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CANDIACE
Middle Name:
Last Name:AMORA PICCOLO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 SALTY WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2488
Mailing Address - Country:US
Mailing Address - Phone:714-318-9905
Mailing Address - Fax:
Practice Address - Street 1:488 SALTY WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2488
Practice Address - Country:US
Practice Address - Phone:714-318-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10196307133V00000X
CACDR-1106542133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316377484Medicaid