Provider Demographics
NPI:1831992411
Name:SALAHUDDIN, FAREED (LVN)
Entity type:Individual
Prefix:
First Name:FAREED
Middle Name:
Last Name:SALAHUDDIN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 CREEKSIDE VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3366
Mailing Address - Country:US
Mailing Address - Phone:619-386-9677
Mailing Address - Fax:
Practice Address - Street 1:2770 CREEKSIDE VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3366
Practice Address - Country:US
Practice Address - Phone:619-386-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704853164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse