Provider Demographics
NPI:1710995022
Name:SALERNO, JUSTIN LOUIS
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:LOUIS
Last Name:SALERNO
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 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-673-3930
Mailing Address - Fax:805-659-3217
Practice Address - Street 1:2100 STATHAM BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033
Practice Address - Country:US
Practice Address - Phone:805-330-8680
Practice Address - Fax:805-728-1428
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56416207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G564160Medicaid
CAG56416OtherCA MEDICAL LICENSE
CAG56416OtherCA MEDICAL LICENSE
CA00G564160Medicaid
00G564161Medicare PIN