Healthcare Provider Details

I. General information

NPI: 1043392467
Provider Name (Legal Business Name): ADRIANA SALAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/27/2024
Certification Date: 04/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

7629 CIRCLE DR
LEMON GROVE CA
91945-3810
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax: 858-642-6255
Mailing address:
  • Phone: 619-981-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16078
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number16078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: