Provider Demographics
NPI:1710995022
Name:SALERNO, JUSTIN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LOUIS
Last Name:SALERNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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 1:1551 BISHOP ST
Practice Address - Street 2:B240
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-549-0402
Practice Address - Fax:805-549-0465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56416207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G564160Medicaid
CAG56416OtherCA MEDICAL LICENSE
CAG56416OtherCA MEDICAL LICENSE
CA00G564160Medicaid
00G564161Medicare PIN