Provider Demographics
NPI:1538140488
Name:CHOTOCRUZ, YASMIN (ND)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:CHOTOCRUZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17160 NW MEADOW GRASS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4612
Mailing Address - Country:US
Mailing Address - Phone:503-439-9464
Mailing Address - Fax:
Practice Address - Street 1:10360 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3927
Practice Address - Country:US
Practice Address - Phone:503-252-8125
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1217175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR299907Medicaid
ORMC1320249OtherDEA REGISTRATION NUMBER