Provider Demographics
NPI:1821366451
Name:CURCIO, PETER ANTHONY (RD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:CURCIO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 SE 144TH LOOP
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8324
Mailing Address - Country:US
Mailing Address - Phone:503-804-4473
Mailing Address - Fax:
Practice Address - Street 1:10615 SE 144TH LOOP
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8324
Practice Address - Country:US
Practice Address - Phone:503-804-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10146080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered