Healthcare Provider Details

I. General information

NPI: 1184551491
Provider Name (Legal Business Name): YAIMA SALAZAR OLIVA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 N 63RD AVE APT 216
GLENDALE AZ
85301-4371
US

IV. Provider business mailing address

6240 N 63RD AVE APT 216
GLENDALE AZ
85301-4371
US

V. Phone/Fax

Practice location:
  • Phone: 954-614-5709
  • Fax:
Mailing address:
  • Phone: 954-614-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3084-P.A.
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3084-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: