Basic Information
Provider Information | |||||||||
NPI: | 1205210218 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SALMA JESMIN MD PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3225 N 75TH ST | ||||||||
Address2: | SUITE 125 | ||||||||
City: | SCOTTSDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 852516909 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4807185986 | ||||||||
FaxNumber: | 4809472494 | ||||||||
Practice Location | |||||||||
Address1: | 3225 N 75TH ST | ||||||||
Address2: | SUITE 125 | ||||||||
City: | SCOTTSDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 852516909 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4807185986 | ||||||||
FaxNumber: | 4809472494 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2015 | ||||||||
LastUpdateDate: | 07/20/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JESMIN | ||||||||
AuthorizedOfficialFirstName: | SALMA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 4807185986 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 33279 | AZ | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
No ID Information.