Healthcare Provider Details

I. General information

NPI: 1114741923
Provider Name (Legal Business Name): JENNIFER SALAZAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 VAN BUREN BLVD
RIVERSIDE CA
92503-3620
US

IV. Provider business mailing address

30855 MOUNTAIN ASH
MENIFEE CA
92584-2932
US

V. Phone/Fax

Practice location:
  • Phone: 866-883-0119
  • Fax:
Mailing address:
  • Phone: 909-316-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: