Provider Demographics
NPI:1164554457
Name:SALAZAR, JOE (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25461 FITZGERALD AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-2315
Mailing Address - Country:US
Mailing Address - Phone:661-607-8964
Mailing Address - Fax:661-254-5580
Practice Address - Street 1:1454 CLOVERFIELD BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2980
Practice Address - Country:US
Practice Address - Phone:661-607-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11492171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist