Healthcare Provider Details

I. General information

NPI: 1306045281
Provider Name (Legal Business Name): NICOLAS DARIO CANON SALAZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 1043
SAN FRANCISCO CA
94102-1301
US

IV. Provider business mailing address

490 POST ST STE 1043
SAN FRANCISCO CA
94102-1301
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116019347
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA133438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: