Healthcare Provider Details

I. General information

NPI: 1053229161
Provider Name (Legal Business Name): ANASTASIA KATHLEEN SALMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAGE KATHLEEN SALMON

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 SANTA CLARA AVE STE 205
OAKLAND CA
94610-1323
US

IV. Provider business mailing address

25400 CARLOS BEE BLVD APT 154
HAYWARD CA
94542-1559
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-1929
  • Fax: 510-601-1947
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: