Provider Demographics
NPI:1023622586
Name:MARINA A SALAMA MD INC
Entity type:Organization
Organization Name:MARINA A SALAMA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-353-5111
Mailing Address - Street 1:5131 GENESTA AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3450
Mailing Address - Country:US
Mailing Address - Phone:540-353-5111
Mailing Address - Fax:
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4597
Practice Address - Country:US
Practice Address - Phone:818-782-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC694921OtherTHE AMERICAN BOARD OF PEDIATRICS
CA1730479809Medicaid
CAA125617OtherMEDICAL LICENSE
CAFS4498083OtherDRUG ENFORCEMENT ADMINISTRATION (DEA)