Provider Demographics
NPI:1467167189
Name:SALMON, MARY ELAINE ESCASIO
Entity Type:Individual
Prefix:
First Name:MARY ELAINE
Middle Name:ESCASIO
Last Name:SALMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ESCASIO
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6890
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN CLUB
Mailing Address - State:CA
Mailing Address - Zip Code:93222-6890
Mailing Address - Country:US
Mailing Address - Phone:661-477-6356
Mailing Address - Fax:
Practice Address - Street 1:641 MAPLE POINT DR E
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3170
Practice Address - Country:US
Practice Address - Phone:661-477-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48339377172A00000X
174200000X, 251E00000X, 374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide