Individual
NOE PONCE MAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3494 LIBERTY RD S, SALEM, OR 97302-4607
(971) 304-0660
Mailing address
3494 LIBERTY RD S, SALEM, OR 97302-4607
(971) 304-0660
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
3215985
OR
Other
Enumeration date
12/16/2021
Last updated
12/16/2021
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