Provider Demographics
NPI:1932552916
Name:SALVATIERRA LOPEZ, ANTHONY JOSE
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSE
Last Name:SALVATIERRA LOPEZ
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 1:11027 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2431
Mailing Address - Country:US
Mailing Address - Phone:818-985-8323
Mailing Address - Fax:
Practice Address - Street 1:11027 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2431
Practice Address - Country:US
Practice Address - Phone:818-985-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA683289164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No174400000XOther Service ProvidersSpecialist