Provider Demographics
NPI:1003227463
Name:SALAZAR, CESAR MAXIMILIAN
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:MAXIMILIAN
Last Name: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 1:209 S BREA BLVD.
Mailing Address - Street 2:APT. 306
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4038
Mailing Address - Country:US
Mailing Address - Phone:714-209-7764
Mailing Address - Fax:
Practice Address - Street 1:499 LOMA ALTA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6227
Practice Address - Country:US
Practice Address - Phone:408-354-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health