Provider Demographics
NPI:1811159221
Name:SALO, CLINT HAROLD (DO)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:HAROLD
Last Name:SALO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18228
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-8228
Mailing Address - Country:US
Mailing Address - Phone:949-955-2101
Mailing Address - Fax:949-390-6519
Practice Address - Street 1:17782 COWAN
Practice Address - Street 2:SUITE A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6030
Practice Address - Country:US
Practice Address - Phone:949-722-7118
Practice Address - Fax:949-722-7119
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A121212084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry