Provider Demographics
NPI:1881879377
Name:SALAZAR, PLACIDO
Entity type:Individual
Prefix:MR
First Name:PLACIDO
Middle Name:
Last Name:SALAZAR
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 1:20 FOREST AVE. (P. O. BOX 243)
Mailing Address - Street 2:
Mailing Address - City:FOREST KNOLLS
Mailing Address - State:CA
Mailing Address - Zip Code:94933
Mailing Address - Country:US
Mailing Address - Phone:415-456-9350
Mailing Address - Fax:415-456-1508
Practice Address - Street 1:914 MISSION AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-6106
Practice Address - Country:US
Practice Address - Phone:415-456-9350
Practice Address - Fax:415-456-1508
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health