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General NPI Number Information
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NPI Number | 1790397602
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Entity Type | Individual
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Provider Name | SHANELLE RODRIGUEZ SALAZAR
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 200 W CENTER STREET PROMENADE
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City | ANAHEIM
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State | CA
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Zip | 92805-3960
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Country | US
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Telephone | 714-618-9540
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Fax |
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Provider Business Mailing Address
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Address Line | 680 S BERENDO ST APT 325
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City | LOS ANGELES
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State | CA
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Zip | 90005-1793
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Country | US
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Telephone | 619-746-0495
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 89814
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License Number State | CA
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