Healthcare Provider Details

I. General information

NPI: 1548471626
Provider Name (Legal Business Name): SALPI SALIBIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 225
NEWPORT BEACH CA
92663-3667
US

IV. Provider business mailing address

64 DISTANT STAR
IRVINE CA
92618-8817
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-0300
  • Fax: 949-360-6932
Mailing address:
  • Phone: 949-371-3196
  • Fax: 949-360-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAP1881
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: