Provider Demographics
NPI:1922784206
Name:SAN JUAN, SALINA DANIELLE
Entity Type:Individual
Prefix:
First Name:SALINA
Middle Name:DANIELLE
Last Name:SAN JUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALINA
Other - Middle Name:DANIELLE
Other - Last Name:ZABALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 STARLING LN
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3077
Mailing Address - Country:US
Mailing Address - Phone:408-888-8234
Mailing Address - Fax:
Practice Address - Street 1:9015 MURRAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3675
Practice Address - Country:US
Practice Address - Phone:831-239-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program