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General NPI Number Information
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NPI Number | 1114381555
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Entity Type | Organization
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Legal Business Name | TRISTAR HOME VISIT PROVIDERS INC
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 26593 AZALEA ST
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3526
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Country | US
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Telephone | 909-565-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 26593 AZALEA ST
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3526
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Country | US
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Telephone | 909-565-8384
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA VICTORIA T SALCEDO
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Credential | NP
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Telephone | 909-565-8384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21506
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License Number State | CA
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