Healthcare Provider Details

I. General information

NPI: 1871485821
Provider Name (Legal Business Name): LISANDRO SALAMANCA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LAKEVIEW AVE
WOODLAKE CA
93286-1301
US

IV. Provider business mailing address

1403 E BUENA VISTA AVE
VISALIA CA
93292-7322
US

V. Phone/Fax

Practice location:
  • Phone: 559-564-0100
  • Fax:
Mailing address:
  • Phone: 559-802-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95214862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: