Healthcare Provider Details

I. General information

NPI: 1619898681
Provider Name (Legal Business Name): CENTRAL VALLEY ELECTROLYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MARKET ST NE STE 327
SALEM OR
97301-1834
US

IV. Provider business mailing address

182 GREENCREST ST NE APT 302
SALEM OR
97301-5273
US

V. Phone/Fax

Practice location:
  • Phone: 971-707-0387
  • Fax:
Mailing address:
  • Phone: 971-707-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY KINTZ
Title or Position: OWNER
Credential:
Phone: 971-707-0387