MEDICARE: ALEXIS SALINAS

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1588133102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS SALINAS

Provider Business Mailing Address
First Line	:	719 LIBERTY AVE
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146
Country	:	US
Telephone Number	:	313-693-3813
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 PORTER ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-4812
Country	:	US
Telephone Number	:	248-719-0779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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Directions to “ ALEXIS SALINAS ” Practice Location

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