Provider Demographics
NPI:1629685789
Name:SALALILA, AILEEN CORTEZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:CORTEZ
Last Name:SALALILA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 BALBOA AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6952
Mailing Address - Country:US
Mailing Address - Phone:858-565-6394
Mailing Address - Fax:
Practice Address - Street 1:5222 BALBOA AVE STE 31
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6952
Practice Address - Country:US
Practice Address - Phone:858-565-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty