Healthcare Provider Details

I. General information

NPI: 1457136053
Provider Name (Legal Business Name): RICHARD SALAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E ARROW HWY BLDG E
UPLAND CA
91786-4984
US

IV. Provider business mailing address

1260 E ARROW HWY BLDG E
UPLAND CA
91786-4984
US

V. Phone/Fax

Practice location:
  • Phone: 909-932-1069
  • Fax:
Mailing address:
  • Phone: 909-932-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: