Carole L Matiaco, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

000965 Issued in OR

Practice address

15895 SW 72ND Ave
Suite 250 BLDG B
Tigard, OR 97224-7977

Phone

(503) 624-5630

Fax

(503) 624-9149

NPI assigned

Jun 18, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427414400000",
    "number": "1700149580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15895 SW 72ND AVE",
            "address_2": "SUITE 250",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247977",
            "telephone_number": "503-624-5630",
            "fax_number": "503-624-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15895 SW 72ND AVE",
            "address_2": "SUITE 250 BLDG B",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247977",
            "telephone_number": "503-624-5630",
            "fax_number": "503-624-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATIACO",
        "first_name": "CAROLE",
        "middle_name": "L",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2015-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "000965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5000662380",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Massingale, LCSW
• Phoebe M Mata
• Megan Matheis
• Sandra Matheson
• Devon A Mathews, CADCII
• Hiroshi Matsushita
• Amanda Ann Matthews
• Amanda Jean Matthews, LCSW-1354
• Erica Dawn Mattson
• Misty Laura Matusch

• Registered Dietitian in Tigard, OR
• Providers in Tigard, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.