Healthcare Provider Details
I. General information
NPI: 1962028936
Provider Name (Legal Business Name): SAL PSYCHIATRY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/24/2020
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
13132 STUDEBAKER RD STE 10
NORWALK CA
90650-2576
US
IV. Provider business mailing address
13132 STUDEBAKER RD STE 10
NORWALK CA
90650-2576
US
V. Phone/Fax
- Phone: 989-475-2543
- Fax:
- Phone: 562-280-7176
- Fax: 562-262-0735
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084A0401X |
| Taxonomy | Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
SALISU
ADEJO
AIKOYE
Title or Position: OWNER
Credential: MD
Phone: 989-475-2543