Provider Demographics
NPI:1225163140
Name:LASALA, SALVADOR E (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:E
Last Name:LASALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 W HOSPITALITY LN
Mailing Address - Street 2:STE. 400
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:909-382-3087
Mailing Address - Fax:909-382-3106
Practice Address - Street 1:268 W HOSPITALITY LN
Practice Address - Street 2:STE. 400
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0001
Practice Address - Country:US
Practice Address - Phone:909-382-3087
Practice Address - Fax:909-382-3106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA526162084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry