Provider Demographics
NPI:1003174285
Name:DE LA CRUZ, J SALVADOR YALUNG
Entity Type:Individual
Prefix:
First Name:J SALVADOR
Middle Name:YALUNG
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 SW EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6831
Mailing Address - Country:US
Mailing Address - Phone:503-961-3875
Mailing Address - Fax:
Practice Address - Street 1:105 ARNEY RD STE 120
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9472
Practice Address - Country:US
Practice Address - Phone:503-814-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD189150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine