Healthcare Provider Details

I. General information

NPI: 1710505854
Provider Name (Legal Business Name): SALAR BANI HANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E CAROLINE ST STE J
SAN BERNARDINO CA
92408-3758
US

IV. Provider business mailing address

11175 CAMPUS ST RM A1111
LOMA LINDA CA
92350-1700
US

V. Phone/Fax

Practice location:
  • Phone: 909-651-1900
  • Fax:
Mailing address:
  • Phone: 909-558-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA202422
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA202422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: