Healthcare Provider Details

I. General information

NPI: 1366634032
Provider Name (Legal Business Name): CARLOS MANALO SALAZAR RN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 POTRERO AVE
SAN FRANCISCO CA
94110-2116
US

IV. Provider business mailing address

50 IVY ST (LECH WALESA)
SAN FRANCISCO CA
94102-4506
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-6942
  • Fax: 415-206-6851
Mailing address:
  • Phone: 415-355-7427
  • Fax: 415-355-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number500363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: