Healthcare Provider Details

I. General information

NPI: 1184190845
Provider Name (Legal Business Name): AMBER NICOLE SALGADO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33685 HARVEST WAY EAST
WILDOMAR CA
92595
US

IV. Provider business mailing address

33685 HARVEST WAY EAST
WILDOMAR CA
92595
US

V. Phone/Fax

Practice location:
  • Phone: 951-805-2908
  • Fax:
Mailing address:
  • Phone: 951-805-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number293039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: