Provider Demographics
NPI:1073569497
Name:SALSAMEDA, ROBERT E (RNP, MSN, CRNFA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SALSAMEDA
Suffix:
Gender:M
Credentials:RNP, MSN, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17360 BROOKHURST ST
Mailing Address - Street 2:ATTN: MCMF - CREDENTIALING DEPARTMENT
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3828 SCHAUFELE AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1791
Practice Address - Country:US
Practice Address - Phone:562-427-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN262754163WM0705X
CANP 13934363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN2627540Medicaid
CARN2627540Medicaid