Provider Demographics
NPI:1871634980
Name:DIAMOND, MAUREEN P (RD, LD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:P
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD
Mailing Address - Street 1:9519 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6501
Mailing Address - Country:US
Mailing Address - Phone:503-244-7713
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:UHN 69
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-3779
Practice Address - Fax:503-494-3769
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116741Medicare PIN