Individual provider Active NPI

Leticia G. Salazar, PA-C

  • Medical Physician Assistant
  • Watsonville, CA
National Provider Identifier
1316112980
Registry record updated Apr 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA19667 Issued in CA
Practice address
204 E Beach St
Watsonville, CA 95076-4809
Phone
(831) 728-0222
Fax
(831) 707-2777
NPI assigned
Apr 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 19667 CA
Medical Physician Assistant 363AM0700X PA19667 CA Primary

Addresses

Primary practice location

204 E Beach St
Watsonville, CA 95076-4809

Mailing address

PO Box 1870
Watsonville, CA 95077-1870
Phone (831) 728-0222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100910000701 CA Practitioner - Physician Assistant 4284759457 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 19667CAMDMedical Physician Assistant
PA19667CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Salud Para la Gente CurrentSince Jan 14, 2015 Accepting new patients
Salud Para la Gente CurrentSince Jan 14, 2015 Accepting new patients
Cep America - California CurrentSince Sep 15, 2022 Accepting new patients
Cep America - California CurrentSince Sep 15, 2022 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

204 E Beach St
Watsonville, CA 95076
Phone (831) 763-3413

195 Aviation Way
Ste 200
Watsonville, CA 95076

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1316112980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1870",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950771870",
            "telephone_number": "831-728-0222",
            "fax_number": "831-707-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E BEACH ST",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950764809",
            "telephone_number": "831-728-0222",
            "fax_number": "831-707-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALAZAR",
        "first_name": "LETICIA",
        "middle_name": "G.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA 19667",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA19667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watsonville, CA

Sources for this page

Verify at the official NPI Registry.