Basic Information
| Provider Information | |||||||||
| NPI: | 1922771153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALASWATKINS | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 BERMUDA DR | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923746268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095561969 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9916 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917633201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094502502 | ||||||||
| FaxNumber: | 9094502637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2021 | ||||||||
| LastUpdateDate: | 07/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.