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General NPI Number Information
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NPI Number | 1225857394
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Entity Type | Individual
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Provider Name | RYAN SALT PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 13975 MONO WAY STE G
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City | SONORA
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State | CA
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Zip | 95370-2824
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Country | US
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Telephone | 209-533-9600
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Fax | 209-533-9608
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Provider Business Mailing Address
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Address Line | 7314 WESTERLY WAY
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City | EASTVALE
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State | CA
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Zip | 92880-9089
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Country | US
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Telephone | 714-262-6438
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10736
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA65267
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License Number State | CA
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