Provider Demographics
NPI:1124633680
Name:SALAZAR, ELIZABETH DAMARIS (RDA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAMARIS
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 1:3995 BARBURY PALMS WAY
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7473
Mailing Address - Country:US
Mailing Address - Phone:951-940-6433
Mailing Address - Fax:
Practice Address - Street 1:3380 LA SIERRA AVE STE 108
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5225
Practice Address - Country:US
Practice Address - Phone:951-465-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA88848126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant