Provider Demographics
NPI:1760757587
Name:SALAS-AMIGON, BRENDA (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SALAS-AMIGON
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31924 DEERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3565
Mailing Address - Country:US
Mailing Address - Phone:973-224-7544
Mailing Address - Fax:
Practice Address - Street 1:391 N SAN JACINTO ST
Practice Address - Street 2:DR. HERMAN MATHIAS AND ASSOCIATES
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3118
Practice Address - Country:US
Practice Address - Phone:951-929-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00368300363LF0000X
CA21833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily