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General NPI Number Information
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NPI Number | 1225307804
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Entity Type | Individual
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Provider Name | AVA SEPTE T SALARDA N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 23200 WESTERN AVE APT 101
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City | HARBOR CITY
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State | CA
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Zip | 90710-1054
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Country | US
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Telephone | 310-528-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 12900 PARK PLAZA DR STE 150
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City | CERRITOS
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State | CA
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Zip | 90703-9329
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Country | US
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Telephone | 310-528-0100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP 21315
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License Number State | CA
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