Provider Demographics
NPI:1760516439
Name:SALENGER, STEPHEN EDWARD
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:SALENGER
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 1:12606 VALLEY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7464
Mailing Address - Country:US
Mailing Address - Phone:909-389-9330
Mailing Address - Fax:
Practice Address - Street 1:12606 VALLEY VIEW LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7464
Practice Address - Country:US
Practice Address - Phone:909-389-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA208132084P0800X
WAMD000457362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C 5305Medicare UPIN