Healthcare Provider Details

I. General information

NPI: 1114101805
Provider Name (Legal Business Name): LAURIE MARIE SALAMEH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 02/11/2022
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD ATTN: ACAMEDIC AFFAIRS
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

1800 HARRISON ST 7TH FL
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3538
  • Fax:
Mailing address:
  • Phone: 707-571-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A11026
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR982
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: