Individual
ANTONIO A DE SALLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 MEDICAL PLAZA, #200, LOS ANGELES, CA 90095-0001
(310) 825-5111
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5632
(310) 825-5111
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
A51650
CA
208600000X
Surgery Physician
A51650
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A516500
—
CA
Enumeration date
08/10/2006
Last updated
07/16/2010
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