Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 60887 | CA |
N | 213EG0000X | General Practice | 60887 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 60887 | CA |
NPI | 1063795797 |
---|---|
Provider Name | Dr. Roberto Salazar |
First Address | San Marcos, CA 92078-2338 |
Second Address | San Marcos, CA 92078-2338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2011 |
Last Update Date | 15/07/2021 |