Provider Demographics
NPI:1598392466
Name:SALGUERO, PAULINE IMELDA
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:IMELDA
Last Name:SALGUERO
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 1:4202 MAYBANK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3910
Mailing Address - Country:US
Mailing Address - Phone:562-225-7100
Mailing Address - Fax:
Practice Address - Street 1:4202 MAYBANK AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-3910
Practice Address - Country:US
Practice Address - Phone:562-225-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant