Provider Demographics
NPI:1366058935
Name:SALISBURY, FATEMEH MOGHADAM
Entity type:Individual
Prefix:MRS
First Name:FATEMEH
Middle Name:MOGHADAM
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SETTLERS BND N
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-6012
Mailing Address - Country:US
Mailing Address - Phone:949-226-1068
Mailing Address - Fax:
Practice Address - Street 1:1905 SETTLERS BND N
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-6012
Practice Address - Country:US
Practice Address - Phone:949-226-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies