Provider Demographics
NPI:1851860290
Name:AGUILAR SALGADO, SAMARA ABIGAIL
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:ABIGAIL
Last Name:AGUILAR SALGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2723 EL VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2011
Mailing Address - Country:US
Mailing Address - Phone:408-348-1598
Mailing Address - Fax:
Practice Address - Street 1:36 OAK LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2629
Practice Address - Country:US
Practice Address - Phone:650-938-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician