Healthcare Provider Details

I. General information

NPI: 1124633680
Provider Name (Legal Business Name): ELIZABETH DAMARIS SALAZAR RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 LA SIERRA AVE STE 108
RIVERSIDE CA
92503-5225
US

IV. Provider business mailing address

3995 BARBURY PALMS WAY
PERRIS CA
92571-7473
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-6982
  • Fax:
Mailing address:
  • Phone: 951-940-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA88848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: