Healthcare Provider Details

I. General information

NPI: 1689508095
Provider Name (Legal Business Name): MARIAN RAGAIE AZIZ SALAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42150 JACKSON ST BLDG A
INDIO CA
92203-9763
US

IV. Provider business mailing address

79795 RANDOLPH CT
LA QUINTA CA
92253-4070
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-0326
  • Fax:
Mailing address:
  • Phone: 760-285-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: