Provider Demographics
NPI:1497267876
Name:SALAKO, CHIDINMA GRACE
Entity Type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:GRACE
Last Name:SALAKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 E VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5793
Mailing Address - Country:US
Mailing Address - Phone:480-749-8176
Mailing Address - Fax:
Practice Address - Street 1:1918 E VINEYARD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5793
Practice Address - Country:US
Practice Address - Phone:480-749-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ45-5405477OtherPRIMARY CAREGIVER