Provider Demographics
NPI:1003190299
Name:BLANCAS, SALVADOR (SUDCC #8399)
Entity type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:
Last Name:BLANCAS
Suffix:
Gender:M
Credentials:SUDCC #8399
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-244-1444
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:401 BRIARFIELD WAY
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002
Practice Address - Country:US
Practice Address - Phone:650-369-4598
Practice Address - Fax:650-244-1447
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB1401221633OtherAOD COUNSELOR