Individual
NELLIE I DIAZ DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PWS
Contact information
Practice address
1011 COMMERCIAL ST NE, SALEM, OR 97301-1049
(503) 983-9900
Mailing address
3652 SUNNYVIEW RD NE, SALEM, OR 97305-1016
(503) 302-5650
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000109409
OR
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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