Provider Demographics
NPI:1902846702
Name:DELACRUZ, NORIKO N (RD)
Entity Type:Individual
Prefix:
First Name:NORIKO
Middle Name:N
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NORIKO
Other - Middle Name:N
Other - Last Name:NARITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1253
Mailing Address - Fax:360-729-3185
Practice Address - Street 1:1200 HILYARD ST STE 550
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8153
Practice Address - Country:US
Practice Address - Phone:458-205-6543
Practice Address - Fax:458-205-6492
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM941714133V00000X
ORLD-D-10196283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM941714OtherCOMMISSION DIETETIC REGIS
AZ104961Medicare PIN