Provider Demographics
NPI:1043587728
Name:SALAS, ANGELA MARIA (MS, RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:SALAS
Suffix:
Gender:F
Credentials:MS, RD, IBCLC
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 750537
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-0537
Mailing Address - Country:US
Mailing Address - Phone:718-309-8036
Mailing Address - Fax:
Practice Address - Street 1:6550 WETHEROLE ST APT 3D
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4716
Practice Address - Country:US
Practice Address - Phone:718-309-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered