| Pacific Coast Clinic Salem Llc | |
|
1249 Fairview Ave Se Salem OR 97302-2534 | |
| (971) 239-1146 | |
| (503) 907-9933 |
| Full Name | Pacific Coast Clinic Salem Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1249 Fairview Ave Se, Salem, Oregon |
| Authorized Official Name and Position | Erum Ayaz Khaleeq (PSYCHIATRIST) |
| Authorized Official Contact | 9712391146 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Coast Clinic Salem Llc 1249 Fairview Ave Se Salem OR 97302-2534 Ph: (971) 239-1146 | Pacific Coast Clinic Salem Llc 1249 Fairview Ave Se Salem OR 97302-2534 Ph: (971) 239-1146 |
| NPI Number | 1669704805 |
|---|---|
| Provider Enumeration Date | 02/11/2010 |
| Last Update Date | 06/01/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669704805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | MD24295 (Oregon) | Primary |
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