Provider Demographics
NPI:1891305942
Name:SALAS, MIGUEL ANGEL (BCBA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:SALAS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:
Other - Last Name:SALAS-CANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 10827
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-2827
Mailing Address - Country:US
Mailing Address - Phone:850-521-0242
Mailing Address - Fax:
Practice Address - Street 1:3223 NW 10TH TER STE 610
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5940
Practice Address - Country:US
Practice Address - Phone:206-854-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-06-3036103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst