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NPI Code Detail

MEDICARE: MARIO DE OBALDIA JR. MS MFT

MEDICARE: MARIO DE OBALDIA JR. MS MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1932239852
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO DE OBALDIA JR. MS MFT
Provider Business Mailing Address
First Line : 5438 KAYAK WAY NE
Second Line :
City : KEIZER
State : OR
Zip : 97303
Country : US
Telephone Number : 818-335-1099
Fax Number :
Provider Business Practice Location Address
First Line : 1118 OAK ST SE
Second Line :
City : SALEM
State : OR
Zip : 97301-4019
Country : US
Telephone Number : 503-302-9295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/21/2022

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