Individual
MR. JESSE ENRIQUE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7585 NW MOUNTAIN VIEW DR, CORVALLIS, OR 97330-9751
(541) 231-1872
Mailing address
7585 NW MOUNTAIN VIEW DR, CORVALLIS, OR 97330-9751
(541) 231-1827
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/25/2016
Last updated
11/25/2016
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