Individual
MARIDEE TA'TIERRA TUDELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3876 BEVERLY AVE NE BLDG G, SALEM, OR 97305-1319
(503) 763-5735
Mailing address
4939 PERIWINKLE DR SE, SALEM, OR 97317-5000
(503) 851-2705
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/30/2017
Last updated
06/30/2017
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