Provider Demographics
NPI:1437103868
Name:SALONE, LAVORIAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAVORIAL
Middle Name:
Last Name:SALONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N EL CAMINO REAL
Mailing Address - Street 2:SPC 65
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1781
Mailing Address - Country:US
Mailing Address - Phone:760-599-7085
Mailing Address - Fax:760-599-5820
Practice Address - Street 1:3636 4TH AVE
Practice Address - Street 2:STE 302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4294
Practice Address - Country:US
Practice Address - Phone:760-599-7085
Practice Address - Fax:760-599-5820
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00290777OtherRAILROAD
CAPSY187770Medicaid
CAWCP18777AOtherRAILROAD
CAPSY187770Medicaid