Provider Demographics
NPI:1447057732
Name:VERASTEGUI ESPINOZA, MAR DEL SOL (CHW)
Entity type:Individual
Prefix:
First Name:MAR DEL SOL
Middle Name:
Last Name:VERASTEGUI ESPINOZA
Suffix:
Gender:
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 HAWTHORNE AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-581-0043
Practice Address - Street 1:610 HAWTHORNE AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5378
Practice Address - Country:US
Practice Address - Phone:503-446-0029
Practice Address - Fax:503-581-0043
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113104172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker