Individual
BRYAN DANIEL BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
200 GWEE SHUT RD, SILETZ, OR 97380-2036
(541) 444-9631
Mailing address
PO BOX 320, SILETZ, OR 97380-0320
(541) 444-9631
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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