Individual
JUAN CARLOS DIAZ OLIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-1
Contact information
Practice address
236 SE D ST, MADRAS, OR 97741-1619
(541) 233-9125
Mailing address
236 SE D ST, MADRAS, OR 97741-1619
(541) 233-9125
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23-08-10841
OR
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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