Healthcare Provider Details

I. General information

NPI: 1760309900
Provider Name (Legal Business Name): JOHANNA AGUIRRE SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N 2ND AVE
UPLAND CA
91786-6019
US

IV. Provider business mailing address

199 N 2ND AVE
UPLAND CA
91786-6019
US

V. Phone/Fax

Practice location:
  • Phone: 909-321-9000
  • Fax: 909-321-2660
Mailing address:
  • Phone: 909-321-9000
  • Fax: 909-321-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: