Provider Demographics
NPI:1679124572
Name:TRUVAL, KATYNA KRYSTEN (ND, MPH)
Entity type:Individual
Prefix:
First Name:KATYNA
Middle Name:KRYSTEN
Last Name:TRUVAL
Suffix:
Gender:F
Credentials:ND, MPH
Other - Prefix:
Other - First Name:KATYNA-KRYSTEN
Other - Middle Name:
Other - Last Name:OMIDFAR-TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND, MPH
Mailing Address - Street 1:1148 SW 57TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2546
Mailing Address - Country:US
Mailing Address - Phone:702-696-8701
Mailing Address - Fax:
Practice Address - Street 1:15962 BOONES FERRY RD STE 209
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4360
Practice Address - Country:US
Practice Address - Phone:971-979-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4278OtherMEDICAL LICENSE
OR500778784Medicaid