Healthcare Provider Details

I. General information

NPI: 1578428603
Provider Name (Legal Business Name): MARK TERENCE ESTRADA SALAMAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 W FLYNN LN
GLENDALE AZ
85305-3406
US

IV. Provider business mailing address

8760 W FLYNN LN
GLENDALE AZ
85305-3406
US

V. Phone/Fax

Practice location:
  • Phone: 818-462-1842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number332533
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: