Provider Demographics
NPI:1760682504
Name:SALAZAR, SANDRA LETICIA (MD)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LETICIA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LETICIA
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9436 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4748
Mailing Address - Country:US
Mailing Address - Phone:562-949-6069
Mailing Address - Fax:562-654-2817
Practice Address - Street 1:9436 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-949-6069
Practice Address - Fax:562-654-2817
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine