Healthcare Provider Details

I. General information

NPI: 1679157861
Provider Name (Legal Business Name): CHRISTOPHER SALDIVAR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/20/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26741 PORTOLA PKWY STE 1E122
FOOTHILL RANCH CA
92610-1743
US

IV. Provider business mailing address

26741 PORTOLA PKWY STE 1E122
FOOTHILL RANCH CA
92610-1743
US

V. Phone/Fax

Practice location:
  • Phone: 949-288-3377
  • Fax:
Mailing address:
  • Phone: 949-288-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: