Healthcare Provider Details

I. General information

NPI: 1912825530
Provider Name (Legal Business Name): JOSHUA ANTON SALAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W FOOTHILL BLVD STE 250
UPLAND CA
91786-3786
US

IV. Provider business mailing address

5231 BELVEDERE WAY
MONTCLAIR CA
91763-6203
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-8641
  • Fax:
Mailing address:
  • Phone: 951-384-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: