Healthcare Provider Details

I. General information

NPI: 1669407102
Provider Name (Legal Business Name): LOUIS SALAZAR C.F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MAIN ST
SANTA ANA CA
92701-3576
US

IV. Provider business mailing address

825 E CENTRAL AVE
SAN BERNARDINO CA
92408-2413
US

V. Phone/Fax

Practice location:
  • Phone: 657-282-6355
  • Fax:
Mailing address:
  • Phone: 888-261-6210
  • Fax: 262-372-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number514182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number514182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: