Provider Demographics
NPI:1376779587
Name:SALADO, LEONORA MARY
Entity Type:Individual
Prefix:MS
First Name:LEONORA
Middle Name:MARY
Last Name:SALADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 EL CAMINO REAL STE 211
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1328
Mailing Address - Country:US
Mailing Address - Phone:650-559-7529
Mailing Address - Fax:888-893-8780
Practice Address - Street 1:4600 EL CAMINO REAL STE 211
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1328
Practice Address - Country:US
Practice Address - Phone:650-559-7529
Practice Address - Fax:888-893-8780
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109133103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA109133OtherBUSINESS LICENSE