Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 978 | OR |
NPI | 1083743496 |
---|---|
Provider Name | Dr. Rosetta Koach |
First Address | Beaverton, OR 97007-8465 |
Second Address | Beaverton, OR 97007-8465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |