Provider Demographics
NPI:1326120536
Name:ZAMUDIO, SALOMON
Entity Type:Individual
Prefix:
First Name:SALOMON
Middle Name:
Last Name:ZAMUDIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SALOMON
Other - Middle Name:ZAVALA
Other - Last Name:ZAMUDIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1143 LIBERTY ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1047
Mailing Address - Country:US
Mailing Address - Phone:503-588-5825
Mailing Address - Fax:503-361-0383
Practice Address - Street 1:1143 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1047
Practice Address - Country:US
Practice Address - Phone:503-588-5825
Practice Address - Fax:503-315-0722
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR290171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator