Provider Demographics
NPI:1508555103
Name:SALMASAN, CARMINA-AMPARO BUSTAMANTE
Entity Type:Individual
Prefix:
First Name:CARMINA-AMPARO
Middle Name:BUSTAMANTE
Last Name:SALMASAN
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 1:461 VINCA WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7683
Mailing Address - Country:US
Mailing Address - Phone:707-724-1274
Mailing Address - Fax:
Practice Address - Street 1:461 VINCA WAY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7683
Practice Address - Country:US
Practice Address - Phone:707-724-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator