Provider Demographics
NPI:1265892228
Name:SALAS, SHAUN AUGUST
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:AUGUST
Last Name:SALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHANAY
Other - Middle Name:VENICIA
Other - Last Name:SALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:368 FELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5144
Mailing Address - Country:US
Mailing Address - Phone:415-861-0828
Mailing Address - Fax:415-861-0257
Practice Address - Street 1:25 BEULAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3909
Practice Address - Country:US
Practice Address - Phone:415-668-1511
Practice Address - Fax:415-861-0257
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker