Provider Demographics
NPI:1396546701
Name:SALAZAR, RICHARD DAVID I
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:SALAZAR
Suffix:I
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 1:189 S L ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2367
Mailing Address - Country:US
Mailing Address - Phone:661-541-4455
Mailing Address - Fax:
Practice Address - Street 1:11188 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2833
Practice Address - Country:US
Practice Address - Phone:661-541-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker