Provider Demographics
NPI:1609120088
Name:REINOSA-SALMERON, JUAN (DC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:REINOSA-SALMERON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:325 POSADA LN
Practice Address - Street 2:STE A-C
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4003
Practice Address - Country:US
Practice Address - Phone:805-434-1038
Practice Address - Fax:805-434-5932
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551907Medicare Oscar/Certification
CAW1508AMedicare PIN
CA051064Medicare Oscar/Certification
CAW1508CMedicare PIN
CA551978Medicare Oscar/Certification
CAW1508Medicare PIN