Healthcare Provider Details

I. General information

NPI: 1164315164
Provider Name (Legal Business Name): MARIA KRISTINA SALAYOG LLANES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39180 LIBERTY ST STE 205
FREMONT CA
94538-2586
US

IV. Provider business mailing address

1647 SYLVIA ST
HAYWARD CA
94545-2563
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-2000
  • Fax:
Mailing address:
  • Phone: 510-676-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95132638
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: