Basic Information
| Provider Information | |||||||||
| NPI: | 1124308655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 JEFFERSON BLVD STE B195 | ||||||||
| Address2: | |||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956052350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164032970 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 JEFFERSON BLVD STE B195 | ||||||||
| Address2: | |||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956052350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164032970 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2011 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.