Healthcare Provider Details

I. General information

NPI: 1750253340
Provider Name (Legal Business Name): SALOMONE LAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20250 SW ACACIA ST STE 230
NEWPORT BEACH CA
92660-1767
US

IV. Provider business mailing address

20250 SW ACACIA ST STE 230
NEWPORT BEACH CA
92660-1767
US

V. Phone/Fax

Practice location:
  • Phone: 562-290-7813
  • Fax:
Mailing address:
  • Phone: 562-290-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number90112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: