Provider Demographics
NPI:1275816100
Name:SALLER, DENNIS I (LEP)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:I
Last Name:SALLER
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 OASIS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4754
Mailing Address - Country:US
Mailing Address - Phone:714-343-9200
Mailing Address - Fax:
Practice Address - Street 1:9321 OASIS AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4754
Practice Address - Country:US
Practice Address - Phone:714-343-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3219103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool