Provider Demographics
NPI:1164678355
Name:SALIS, DONALD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:DAVID
Last Name:SALIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14359 PIONEER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4850
Mailing Address - Country:US
Mailing Address - Phone:562-864-7279
Mailing Address - Fax:562-406-8606
Practice Address - Street 1:14359 PIONEER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4850
Practice Address - Country:US
Practice Address - Phone:562-864-7279
Practice Address - Fax:562-406-8606
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2015-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA29006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT418ZMedicare PIN