Provider Demographics
NPI:1356223788
Name:SALAZAR, LISSETTE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:LISSETTE
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:52443 LAS PALMAS ST
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-2944
Mailing Address - Country:US
Mailing Address - Phone:760-851-8680
Mailing Address - Fax:
Practice Address - Street 1:44311 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2710
Practice Address - Country:US
Practice Address - Phone:760-773-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily