MEDICARE: ANTHONY SALVADOR

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
1	363LF0000X	Family Nurse Practitioner	95015359	CA

General Provider Information

NPI Number	:	1306448352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY SALVADOR

Provider Business Mailing Address
First Line	:	1391 CLEMENTINE WAY
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-4784
Country	:	US
Telephone Number	:	714-422-5827
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 LINCOLN BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90094-2002
Country	:	US
Telephone Number	:	310-305-9200
Fax Number	:	310-305-2800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2020
Last Update Date	:	12/04/2020

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Directions to “ ANTHONY SALVADOR ” Practice Location

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