Provider Demographics
NPI:1184781932
Name:SALAS, MATHEA S (DO)
Entity type:Individual
Prefix:
First Name:MATHEA
Middle Name:S
Last Name:SALAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MATHEA
Other - Middle Name:
Other - Last Name:SONSTENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12791 CABEZUT RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5926
Mailing Address - Country:US
Mailing Address - Phone:209-532-5524
Mailing Address - Fax:209-532-1513
Practice Address - Street 1:12791 CABEZUT RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5926
Practice Address - Country:US
Practice Address - Phone:209-532-5524
Practice Address - Fax:209-532-1513
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7922207Q00000X
SD7225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA126874Medicare PIN
CAP01423775Medicare PIN
WAG8858769Medicare PIN
WAP00286884Medicare PIN
WAH84850Medicare UPIN
SDS102478Medicare PIN