Provider Demographics
NPI:1003393117
Name:SALAMANCA, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:SALAMANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95690-0442
Mailing Address - Country:US
Mailing Address - Phone:530-566-6006
Mailing Address - Fax:
Practice Address - Street 1:9370 W STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8013
Practice Address - Country:US
Practice Address - Phone:877-828-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician