Provider Demographics
NPI:1295969368
Name:SALAZAR, MARIZA RUBI (RDA)
Entity type:Individual
Prefix:
First Name:MARIZA
Middle Name:RUBI
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS REY
Mailing Address - State:CA
Mailing Address - Zip Code:92068-0606
Mailing Address - Country:US
Mailing Address - Phone:760-703-0648
Mailing Address - Fax:
Practice Address - Street 1:103 AVENIDA DEL GADO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057
Practice Address - Country:US
Practice Address - Phone:760-703-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63852126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant