Provider Demographics
NPI:1275855512
Name:SALIM, SAYYED KHALIS
Entity Type:Individual
Prefix:
First Name:SAYYED
Middle Name:KHALIS
Last Name:SALIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S BURTON ST
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5324
Mailing Address - Country:US
Mailing Address - Phone:805-904-8636
Mailing Address - Fax:
Practice Address - Street 1:170 S BURTON ST
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-5324
Practice Address - Country:US
Practice Address - Phone:805-904-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239417164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse