Healthcare Provider Details

I. General information

NPI: 1952810343
Provider Name (Legal Business Name): SALVATORE ANTHONY LIPUMA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4836 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2101
US

IV. Provider business mailing address

310 WASHINGTON BLVD UNIT 204
MARINA DEL REY CA
90292-5165
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-9506
  • Fax: 818-907-9506
Mailing address:
  • Phone: 248-978-5882
  • Fax: 818-907-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021357
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number55096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: