Provider Demographics
NPI:1902625106
Name:SALAM, WALIU WOLE
Entity type:Individual
Prefix:
First Name:WALIU
Middle Name:WOLE
Last Name:SALAM
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 1:1916 CRESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-2140
Mailing Address - Country:US
Mailing Address - Phone:510-677-8834
Mailing Address - Fax:
Practice Address - Street 1:1916 CRESTWOOD LN
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-2140
Practice Address - Country:US
Practice Address - Phone:510-677-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program