Individual
LAURA BASTIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2645 PORTLAND RD NE, STE 120, SALEM, OR 97301-0198
(503) 390-5637
Mailing address
PO BOX 8049, SALEM, OR 97303-0230
(503) 559-9066
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/06/2012
Last updated
03/06/2012
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