Provider Demographics
NPI:1205698784
Name:ESCAMILLA, MARIE AUGUSTINA (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:AUGUSTINA
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 NE 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6807
Mailing Address - Country:US
Mailing Address - Phone:989-316-6748
Mailing Address - Fax:
Practice Address - Street 1:2230 NW PETTYGROVE ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-227-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education