Healthcare Provider Details

I. General information

NPI: 1538281225
Provider Name (Legal Business Name): MICHAEL SAULIBIO NP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9102 EMPEROR AVE
SAN GABRIEL CA
91775-2019
US

IV. Provider business mailing address

351 E TEMPLE ST
LOS ANGELES CA
90012-3328
US

V. Phone/Fax

Practice location:
  • Phone: 253-651-1098
  • Fax:
Mailing address:
  • Phone: 213-253-5018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001936
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number763379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: