Provider Demographics
NPI:1336371939
Name:SALVADOR, MIRIAM A (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:A
Last Name:SALVADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:ANAYANCI
Other - Last Name:SALVADOR HERMOSILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:115 E WASHINGTON BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3606
Mailing Address - Country:US
Mailing Address - Phone:213-234-5532
Mailing Address - Fax:213-234-5501
Practice Address - Street 1:1437 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-5015
Practice Address - Country:US
Practice Address - Phone:323-268-9900
Practice Address - Fax:213-234-5501
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics