Healthcare Provider Details

I. General information

NPI: 1811755333
Provider Name (Legal Business Name): MALINDA MARIE SALAMA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7774 CHERRY AVE STE C
FONTANA CA
92336-4014
US

IV. Provider business mailing address

30680 ROBERT RD
THOUSAND PALMS CA
92276-6635
US

V. Phone/Fax

Practice location:
  • Phone: 909-281-9512
  • Fax:
Mailing address:
  • Phone: 909-368-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF02241109
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberF02241109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: