Provider Demographics
NPI:1609128479
Name:CORTAL, ANGELA DAWN (ND)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DAWN
Last Name:CORTAL
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 1:960 LIBERTY ST SE STE 210
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4195
Mailing Address - Country:US
Mailing Address - Phone:503-380-5833
Mailing Address - Fax:866-304-0330
Practice Address - Street 1:960 LIBERTY ST SE STE 210
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4195
Practice Address - Country:US
Practice Address - Phone:503-990-8395
Practice Address - Fax:866-304-0330
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1917175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath