Healthcare Provider Details

I. General information

NPI: 1649906108
Provider Name (Legal Business Name): CLAUDIA BELEN MEDINA SALAZAR PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax: 760-736-8740
Mailing address:
  • Phone: 760-736-6767
  • Fax: 760-736-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA62883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: