Provider Demographics
NPI:1205848140
Name:SALAZAR, JUVY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JUVY
Middle Name:S
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUVILUSAN
Other - Middle Name:S
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12760 HESPERIA RD
Mailing Address - Street 2:#C
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:760-241-8088
Mailing Address - Fax:760-241-8803
Practice Address - Street 1:12760 HESPERIA RD
Practice Address - Street 2:#C
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-241-8088
Practice Address - Fax:760-241-8803
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56175208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA56175OtherDEPT OF CONSUMER AFFAIR
CA00A561751Medicaid
CA00A561751Medicaid