Healthcare Provider Details

I. General information

NPI: 1932552916
Provider Name (Legal Business Name): ANTHONY JOSE SALVATIERRA LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11027 BURBANK BLVD
NORTH HOLLYWOOD CA
91601-2431
US

IV. Provider business mailing address

11027 BURBANK BLVD
NORTH HOLLYWOOD CA
91601-2431
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-8323
  • Fax:
Mailing address:
  • Phone: 818-985-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number683289
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: