Basic Information
| Provider Information | |||||||||
| NPI: | 1730479809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAMA | ||||||||
| FirstName: | MARINA | ||||||||
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| Credential: | M.D. | ||||||||
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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: | 914054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187826600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A125617 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | A125617 | 01 | CA | MEDICAL LICENSE | OTHER |