=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528135365
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALINA ESMAIL NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 12/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 844 BRIDGEWATER LN
-----------------------------------------------------
City | WALNUT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-936-4455
-----------------------------------------------------
Fax | 909-595-3334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 844 BRIDGEWATER LN
-----------------------------------------------------
City | WALNUT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91789-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-936-4455
-----------------------------------------------------
Fax | 909-595-3334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN370840
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP 9714
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------