Healthcare Provider Details

I. General information

NPI: 1770103921
Provider Name (Legal Business Name): ELLIKA MARJAN SALARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 V ST STE 1102
SACRAMENTO CA
95817-1445
US

IV. Provider business mailing address

4400 V ST STE 1102
SACRAMENTO CA
95817-1445
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3331
  • Fax:
Mailing address:
  • Phone: 916-734-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMT221126
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA207210
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT221126
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: