Provider Demographics
NPI:1003870114
Name:SALAZAR, ASHLEY JUNEPAULINE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JUNEPAULINE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:SUITE 5600
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-861-4666
Mailing Address - Fax:714-861-4682
Practice Address - Street 1:18111 BROOKHURST STREET
Practice Address - Street 2:SUITE 5600
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-861-4666
Practice Address - Fax:714-861-4682
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16621363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G471930Medicaid
CAP78755Medicare UPIN
CAWPA16621AMedicare ID - Type UnspecifiedMEDICARE PPIN