Provider Demographics
NPI:1831348804
Name:DHARMANTO, AUDREY PARAMITA (RD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:PARAMITA
Last Name:DHARMANTO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 NW OVERLOOK DR APT 2214
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7669
Mailing Address - Country:US
Mailing Address - Phone:559-301-9958
Mailing Address - Fax:
Practice Address - Street 1:2830 NW OVERLOOK DR APT 2214
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7669
Practice Address - Country:US
Practice Address - Phone:559-301-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered