Basic Information
| Provider Information | |||||||||
| NPI: | 1720013246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALEM | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | ELLIOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 RIVER LN | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927061425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145434446 | ||||||||
| FaxNumber: | 7145434446 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 VALLEY VISTA DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917653911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098602166 | ||||||||
| FaxNumber: | 9098605424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103TC0700X | PSY12527 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | PSY12527 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TM1800X | PSY12527 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103T00000X | PSY12527 | CA | X | Behavioral Health & Social Service Providers | Psychologist | 103TP2701X | PSY12527 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.