Individual
RAISA MICHYLOVNA RAZLOGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3530 LIBERTY RD S, SALEM, OR 97302-5622
(503) 856-5166
(503) 581-6102
Mailing address
5206 EDGECREST CT SE, SALEM, OR 97306-1840
(503) 856-5166
(503) 581-6102
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
12184
OR
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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