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General NPI Number Information
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NPI Number | 1639036122
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Entity Type | Individual
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Provider Name | XICLALY IRIS CRUZ VERA
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Gender | Female
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 6444 FAIRWAY AVE SE STE 100
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City | SALEM
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State | OR
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Zip | 97306-3073
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Country | US
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Telephone | 971-901-2731
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Fax | 971-901-3065
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Provider Business Mailing Address
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Address Line | 11465 MONITOR MCKEE RD NE
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City | WOODBURN
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State | OR
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Zip | 97071-9050
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Country | US
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Telephone | 971-720-8045
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Fax | 971-720-8045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OR
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