Provider Demographics
NPI:1003035445
Name:SALGUERO, BYRON OTONIEL (MA)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:OTONIEL
Last Name:SALGUERO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 CHAMINADE ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2590
Mailing Address - Country:US
Mailing Address - Phone:616-510-9027
Mailing Address - Fax:
Practice Address - Street 1:4230 CHAMINADE ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2590
Practice Address - Country:US
Practice Address - Phone:616-510-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00000000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)