Provider Demographics
NPI:1922556786
Name:SALEH, FATIN (OD)
Entity Type:Individual
Prefix:DR
First Name:FATIN
Middle Name:
Last Name:SALEH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12263 HIGHLAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2576
Mailing Address - Country:US
Mailing Address - Phone:909-899-5001
Mailing Address - Fax:909-899-5003
Practice Address - Street 1:12263 HIGHLAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2576
Practice Address - Country:US
Practice Address - Phone:909-899-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3012152W00000X
CA34694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist