Provider Demographics
NPI:1316417736
Name:SALAZAR, MICHELLE DIANE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16647 NEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1733
Mailing Address - Country:US
Mailing Address - Phone:661-505-3515
Mailing Address - Fax:888-770-8469
Practice Address - Street 1:16647 NEARVIEW DR
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-1733
Practice Address - Country:US
Practice Address - Phone:661-505-3515
Practice Address - Fax:888-770-8469
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other