Provider Demographics
NPI:1366696577
Name:SALMON, MICHELLE A (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:SALMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:JOSHUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 54130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0130
Mailing Address - Country:US
Mailing Address - Phone:951-687-3200
Mailing Address - Fax:951-687-8923
Practice Address - Street 1:1011 E DEVONSHIRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3033
Practice Address - Country:US
Practice Address - Phone:951-652-3558
Practice Address - Fax:951-652-5547
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner