Basic Information
| Provider Information | |||||||||
| NPI: | 1023622586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARINA A SALAMA MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5131 GENESTA AVE | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913163450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403535111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15107 VANOWEN ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914054597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187826600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | SALAMA | ||||||||
| AuthorizedOfficialFirstName: | MARINA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5403535111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 694921 | 01 | NC | THE AMERICAN BOARD OF PEDIATRICS | OTHER | 1730479809 | 05 | CA | MEDICAID | A125617 | 01 | CA | MEDICAL LICENSE | OTHER | FS4498083 | 01 | CA | DRUG ENFORCEMENT ADMINISTRATION (DEA) | OTHER |