Provider Demographics
NPI:1174092902
Name:SALO, MARY JANE NERONA (MSN,FNP,PHD)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:NERONA
Last Name:SALO
Suffix:
Gender:F
Credentials:MSN,FNP,PHD
Other - Prefix:
Other - First Name:MARY JANE
Other - Middle Name:CAMARILLO
Other - Last Name:NERONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9010 CAMBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8593
Mailing Address - Country:US
Mailing Address - Phone:707-567-7940
Mailing Address - Fax:
Practice Address - Street 1:100 W AMERICAN CANYON RD STE K6
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-4195
Practice Address - Country:US
Practice Address - Phone:707-567-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily