Healthcare Provider Details

I. General information

NPI: 1740686336
Provider Name (Legal Business Name): SALUS PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD SUITE 318
PASADENA CA
91101-2039
US

IV. Provider business mailing address

595 E COLORADO BLVD SUITE 318
PASADENA CA
91101-2039
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-5581
  • Fax:
Mailing address:
  • Phone: 626-765-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANDREAS DIMEO
Title or Position: PARTNER
Credential: PHD
Phone: 626-765-5581