Healthcare Provider Details

I. General information

NPI: 1598636649
Provider Name (Legal Business Name): MICHELLE ANGELINA SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 DOVE ST
NEWPORT BEACH CA
92660-2840
US

IV. Provider business mailing address

13045 KIOWA RD
APPLE VALLEY CA
92308-6446
US

V. Phone/Fax

Practice location:
  • Phone: 909-206-4595
  • Fax:
Mailing address:
  • Phone: 909-741-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: