=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962047860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIO ALBERTO SALGADO BEHAVIOR TECHNICIAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2019
-----------------------------------------------------
Last Update Date | 10/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BEHAVIORAL HEALTH WORKS 1301 E. ORANGEWOOD AVE.
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-249-1266
-----------------------------------------------------
Fax | 800-685-8191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27777 INKSTER RD
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-5326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-436-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------