Provider Demographics
NPI:1760507016
Name:BREITEN, VALERIA JO (ND, RD, CCH)
Entity Type:Individual
Prefix:DR
First Name:VALERIA
Middle Name:JO
Last Name:BREITEN
Suffix:
Gender:F
Credentials:ND, RD, CCH
Other - Prefix:DR
Other - First Name:VALERIA
Other - Middle Name:
Other - Last Name:WYCKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD, RD
Mailing Address - Street 1:1467 SISKIYOU BLVD # 305
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2336
Mailing Address - Country:US
Mailing Address - Phone:480-688-7442
Mailing Address - Fax:
Practice Address - Street 1:1185 FERN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:480-688-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R399599133V00000X
OR4099175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered