Healthcare Provider Details

I. General information

NPI: 1316872799
Provider Name (Legal Business Name): NICOLAS ALBERTO SALAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 WEST ST STE 414
ANNAPOLIS MD
21401-4198
US

IV. Provider business mailing address

3010 ROSE CREEK CT
OAKTON VA
22124-1782
US

V. Phone/Fax

Practice location:
  • Phone: 240-292-0129
  • Fax:
Mailing address:
  • Phone: 571-619-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: