Individual
MRS. DIANA LIZBETH SAN JUAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
2421 LANCASTER DR NE, SALEM, OR 97305-1220
(503) 361-2720
(503) 585-4990
Mailing address
189 E ELM CT, GERVAIS, OR 97026-9780
(971) 218-0951
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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