Provider Demographics
NPI:1841380565
Name:SALAS, ERNESTO TAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:TAN
Last Name:SALAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27699 JEFFERSON AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2661
Mailing Address - Country:US
Mailing Address - Phone:951-693-1159
Mailing Address - Fax:951-693-1169
Practice Address - Street 1:27699 JEFFERSON AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2661
Practice Address - Country:US
Practice Address - Phone:951-693-1159
Practice Address - Fax:951-693-1169
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA053434173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG09315Medicare UPIN