Healthcare Provider Details

I. General information

NPI: 1720013246
Provider Name (Legal Business Name): RONALD ELLIOTT SALEM PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 VALLEY VISTA DR SUITE 104
DIAMOND BAR CA
91765-3911
US

IV. Provider business mailing address

1230 RIVER LN
SANTA ANA CA
92706-1425
US

V. Phone/Fax

Practice location:
  • Phone: 909-860-2166
  • Fax: 909-860-5424
Mailing address:
  • Phone: 714-543-4446
  • Fax: 714-543-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12527
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12527
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY12527
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY12527
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY12527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: