Corleen Angela Bantugon
Individual provider Active NPI Registered Dietitian · Portland, OR
NPI 1336029479 · NPPES record last updated Sep 8, 2025
Key facts
- NPI
- 1336029479
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- Practice address
- 9155 SW Barnes Rd
Suite 435, Medical Office Building #3
Portland, OR 97225-6625 - Phone
- (503) 216-1234
- NPI assigned
- Sep 8, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | OR | Yes |
Addresses
Primary practice location
9155 SW Barnes Rd
Suite 435, Medical Office Building #3
Portland, OR 97225-6625
Mailing address
9155 SW Barnes Rd
Suite 435, Medical Office Building #3
Portland, OR 97225-6625
Other providers in Portland, OR
- Karly Andrea Keahi Bannister
- Natosha L Bannister
- Aisha Banse
- Modupe Desiree Bansile
- Sandra Ann Banta Wright
- Brian Aoqi Bao
- Roman Baptista
- Asher Joshua Bar-Nes Caldwell
- Anna Alexandra Bar
- Breanna Nicole Baraff
All providers in Portland, OR · Registered Dietitian in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.