Provider Demographics
NPI:1386857266
Name:SALSE, DAVID MICHAEL SR (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:SALSE
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:MICHAEL
Other - Last Name:SALSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:694 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2024
Mailing Address - Country:US
Mailing Address - Phone:626-256-3422
Mailing Address - Fax:626-256-3402
Practice Address - Street 1:694 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2024
Practice Address - Country:US
Practice Address - Phone:626-256-3422
Practice Address - Fax:626-256-3402
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist