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NPI Code Detail

MEDICARE: DR. LAVORIAL SALONE PHD

MEDICARE: DR. LAVORIAL SALONE PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY18777CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00290777OTHERCARAILROAD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3WCP18777AOTHERCARAILROAD

General Provider Information

NPI Number : 1437103868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAVORIAL SALONE PHD
Provider Business Mailing Address
First Line : 200 N EL CAMINO REAL
Second Line : SPC 65
City : OCEANSIDE
State : CA
Zip : 92058-1781
Country : US
Telephone Number : 760-599-7085
Fax Number : 760-599-5820
Provider Business Practice Location Address
First Line : 3636 4TH AVE
Second Line : STE 302
City : SAN DIEGO
State : CA
Zip : 92103-4294
Country : US
Telephone Number : 760-599-7085
Fax Number : 760-599-5820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 07/07/2017

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Directions to “ DR. LAVORIAL SALONE PHD” Practice Location

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