Provider Demographics
NPI:1932639192
Name:DOCTOR CLINT H. SALO INC.
Entity Type:Organization
Organization Name:DOCTOR CLINT H. SALO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:SALO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-354-2422
Mailing Address - Street 1:17962 SEQUOIA CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3357
Mailing Address - Country:US
Mailing Address - Phone:702-354-2422
Mailing Address - Fax:
Practice Address - Street 1:101 S KRAEMER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6109
Practice Address - Country:US
Practice Address - Phone:714-995-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12121OtherSTATE LICENSE