Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD189150 | OR |
NPI | 1003174285 |
---|---|
Provider Name | J Salvador Yalung De La Cruz |
First Address | Wilsonville, OR 97070-6831 |
Second Address | Woodburn, OR 97071-9472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 05/03/2019 |