Healthcare Provider Details

I. General information

NPI: 1619745056
Provider Name (Legal Business Name): MR. MARENDRA B SALIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 CENTER AVE STE 100
RANCHO CUCAMONGA CA
91730-5842
US

IV. Provider business mailing address

24411 NAN CT
DIAMOND BAR CA
91765-4380
US

V. Phone/Fax

Practice location:
  • Phone: 909-980-4755
  • Fax: 909-790-2148
Mailing address:
  • Phone: 909-954-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC10452
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC10452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: