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General NPI Number Information
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NPI Number | 1770803256
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Entity Type | Organization
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Legal Business Name | SALIENT MEDICAL GROUP, INC
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 25020 LAS BRISAS RD #201
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City | MURRIETA
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State | CA
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Zip | 92562-4064
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Country | US
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Telephone | 951-200-4601
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Fax | 951-200-4605
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Provider Business Mailing Address
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Address Line | 25020 LAS BRISAS RD #201
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City | MURRIETA
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State | CA
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Zip | 92562-4064
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Country | US
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Telephone | 951-200-4601
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Fax | 951-200-4605
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Authorized Official
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Title or Position | SECRETARY
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Name | DEBRA ZICKAFOOSE
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Credential | MD
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Telephone | 951-200-4601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A054704
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License Number State | CA
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