Provider Demographics
NPI:1396754321
Name:SALAS MARTINEZ, RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:SALAS MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:SALAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3699 WILSHIRE BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2718
Mailing Address - Country:US
Mailing Address - Phone:323-783-7338
Mailing Address - Fax:323-783-4120
Practice Address - Street 1:3699 WILSHIRE BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2718
Practice Address - Country:US
Practice Address - Phone:323-783-7338
Practice Address - Fax:323-783-4120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72865207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI00129Medicare UPIN