Provider Demographics
NPI:1902448400
Name:NOGUCHI-SALAZAR, KRISTIAN
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:NOGUCHI-SALAZAR
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 1:3305 RICE ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5216
Mailing Address - Country:US
Mailing Address - Phone:305-792-8393
Mailing Address - Fax:305-444-1523
Practice Address - Street 1:1335 N LA BREA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7565
Practice Address - Country:US
Practice Address - Phone:310-246-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist