Provider Demographics
NPI:1104855063
Name:SALAMATI, LORIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:A
Last Name:SALAMATI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22190 SADDLE PEAK RD
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3423
Mailing Address - Country:US
Mailing Address - Phone:310-455-7201
Mailing Address - Fax:818-989-5408
Practice Address - Street 1:1901 SOLAR DRIVE #100
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2642
Practice Address - Country:US
Practice Address - Phone:909-946-5752
Practice Address - Fax:909-985-3858
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2181367500000X
CANA#1281367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNA2181BMedicare ID - Type Unspecified