Healthcare Provider Details

I. General information

NPI: 1295494664
Provider Name (Legal Business Name): JESUS SALAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16552 SUNHILL DR
VICTORVILLE CA
92395-4518
US

IV. Provider business mailing address

16546 VIHO RD
APPLE VALLEY CA
92307
US

V. Phone/Fax

Practice location:
  • Phone: 760-780-4400
  • Fax:
Mailing address:
  • Phone: 909-200-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: