Provider Demographics
NPI:1033703236
Name:SALUDARES, NIKISHA ANN MARIE
Entity Type:Individual
Prefix:
First Name:NIKISHA
Middle Name:ANN MARIE
Last Name:SALUDARES
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 1:2027 OCALA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1659
Mailing Address - Country:US
Mailing Address - Phone:408-750-7269
Mailing Address - Fax:
Practice Address - Street 1:3375 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3110
Practice Address - Country:US
Practice Address - Phone:408-266-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant