Provider Demographics
NPI:1235838798
Name:SALVADOR, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:SALVADOR
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 1:22365 EL TORO RD STE 151
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5053
Mailing Address - Country:US
Mailing Address - Phone:949-698-3814
Mailing Address - Fax:949-860-7221
Practice Address - Street 1:22365 EL TORO RD STE 151
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5053
Practice Address - Country:US
Practice Address - Phone:714-805-9070
Practice Address - Fax:949-860-7221
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician