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1205466018
JAKE GONGORA
SALEM, OR
NPI
1205466018
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
172V00000X Community Health Worker
Enumeration Date
2020-01-21
Last Update Date
2020-01-21
Business Address
Mr. JAKE GONGORA
4890 32ND AVE SE
SALEM, OR 97317-9350
Phone number: 503-588-5647
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Mailing Address
Mr. JAKE GONGORA
4890 32ND AVE SE
SALEM, OR 97317-9350
Phone number: 503-588-5647
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