Provider Demographics
NPI:1295930493
Name:SALOM, MARIA ALEXANDRA (LAC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEXANDRA
Last Name:SALOM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ROHANNA
Other - Middle Name:ALEXANDRA
Other - Last Name:SALOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:5312 CORTEEN PL APT 3
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2576
Mailing Address - Country:US
Mailing Address - Phone:818-761-2833
Mailing Address - Fax:
Practice Address - Street 1:5312 CORTEEN PL APT 3
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2576
Practice Address - Country:US
Practice Address - Phone:818-761-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 252638163WX0002X
CAAC 4720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Not Answered171100000XOther Service ProvidersAcupuncturist