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General NPI Number Information
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NPI Number | 1447495361
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Entity Type | Organization
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Legal Business Name | ERNESTO T. SALAS, MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/05/2008
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 27699 JEFFERSON AVE SUITE 311
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City | TEMECULA
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State | CA
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Zip | 92590-2661
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Country | US
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Telephone | 951-693-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 27699 JEFFERSON AVE SUITE 311
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City | TEMECULA
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State | CA
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Zip | 92590-2661
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARILYN G SALAS
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Credential |
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Telephone | 951-693-1159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A053434
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License Number State | CA
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