Individual
JEANETTE DIBALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SA-C
Contact information
Practice address
342 FAIRVIEW ST, SILVERTON, OR 97381-1917
(503) 873-1713
Mailing address
12353 SILVERTON RD NE, SILVERTON, OR 97381-9363
(503) 428-4983
(503) 873-1707
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
16-379
OR
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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