Healthcare Provider Details

I. General information

NPI: 1679487961
Provider Name (Legal Business Name): NASTEHO SALAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LINCOLN OAK DR
MODESTO CA
95355-9435
US

IV. Provider business mailing address

5368 MONTEREY HWY
SAN JOSE CA
95111-4250
US

V. Phone/Fax

Practice location:
  • Phone: 559-512-3526
  • Fax: 559-272-0226
Mailing address:
  • Phone: 669-252-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: