Provider Demographics
NPI:1972131001
Name:PADRON, VICTORIA R (RD, LD, CD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:PADRON
Suffix:
Gender:F
Credentials:RD, LD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 FAIRVIEW INDUSTRIAL DR SE STE 170
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1174
Mailing Address - Country:US
Mailing Address - Phone:503-371-1970
Mailing Address - Fax:
Practice Address - Street 1:3723 FAIRVIEW INDUSTRIAL DR SE STE 170
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1174
Practice Address - Country:US
Practice Address - Phone:503-371-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR453732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered