Organization
NEWBERG PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAYA JANE MANKA M.D. (OWNER)
(503) 538-7407
Entity
Organization
Contact information
Practice address
308 VILLA RD STE 116, NEWBERG, OR 97132-1881
(503) 538-7407
(503) 537-0640
Mailing address
308 VILLA RD STE 116, NEWBERG, OR 97132-1881
(503) 538-7407
(503) 537-0640
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD10760
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126565
—
OR
Enumeration date
07/25/2008
Last updated
07/25/2008
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