Provider Demographics
NPI:1386372654
Name:SALAS, DIEGO DE JESUS
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:DE JESUS
Last Name:SALAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11449 TREVOR WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-1657
Mailing Address - Country:US
Mailing Address - Phone:951-722-5261
Mailing Address - Fax:
Practice Address - Street 1:11449 TREVOR WAY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-1657
Practice Address - Country:US
Practice Address - Phone:951-722-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant