Organization
PACIFIC COAST CLINIC SALEM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERUM AYAZ KHALEEQ MD (PSYCHIATRIST)
(971) 239-1146
Entity
Organization
Contact information
Practice address
1249 FAIRVIEW AVE SE, SALEM, OR 97302-2534
(971) 239-1146
(503) 907-9933
Mailing address
1249 FAIRVIEW AVE SE, SALEM, OR 97302-2534
(971) 239-1146
(503) 907-9933
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
MD24295
OR
Other
Enumeration date
02/11/2010
Last updated
06/01/2011
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