Provider Demographics
NPI:1154561405
Name:SALAZ, ANDREW E
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:SALAZ
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 1:838 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2408
Mailing Address - Country:US
Mailing Address - Phone:831-754-3635
Mailing Address - Fax:831-754-4733
Practice Address - Street 1:838 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2408
Practice Address - Country:US
Practice Address - Phone:831-754-3635
Practice Address - Fax:831-754-4733
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness