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General NPI Number Information
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NPI Number | 1477440493
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Entity Type | Organization
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Legal Business Name | SALUS MEDICAL COLLECTIVE, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 10 WOODLAND RD
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City | SAINT HELENA
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State | CA
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Zip | 94574-9554
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Country | US
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Telephone | 707-287-8496
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 859
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City | SAINT HELENA
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State | CA
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Zip | 94574-0859
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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 | CEO
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Name | AMIZETTA C CLARK
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Credential | MD
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Telephone | 707-287-8496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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