Provider Demographics
NPI:1154433761
Name:SALAMANCA, ANGELICA G (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:G
Last Name:SALAMANCA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:19054 GRAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6837
Mailing Address - Country:US
Mailing Address - Phone:562-650-7915
Mailing Address - Fax:
Practice Address - Street 1:21739 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3302
Practice Address - Country:US
Practice Address - Phone:310-513-6900
Practice Address - Fax:310-513-1445
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1540152W00000X
CA13414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ118159Medicare PIN