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NPI Code Detail

MEDICARE: SALVADOR E LASALA MD A MEDICAL CORPORATION

MEDICARE: SALVADOR E LASALA MD A MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorA52616CA
22084P0804XChild & Adolescent Psychiatry PhysicianA52616CA
3103TP2701XGroup Psychotherapy PsychologistA52616CA

General Provider Information

NPI Number : 1417161621
Entity Type Code : Organization
Provider Name (Legal Business Name) : SALVADOR E LASALA MD A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 399 E HIGHLAND AVE
Second Line : STE 214
City : SAN BERNARDINO
State : CA
Zip : 92404-3816
Country : US
Telephone Number : 909-886-3100
Fax Number : 909-886-4100
Provider Business Practice Location Address
First Line : 399 E HIGHLAND AVE
Second Line : STE 214
City : SAN BERNARDINO
State : CA
Zip : 92404-3816
Country : US
Telephone Number : 909-886-3100
Fax Number : 909-886-4100
Authorized Official
Title or Position : PRESIDENT
Name : DR. SALVADOR E LASALA
Credential : MD
Telephone Number : 909-886-3100
Provider Enumeration Date : 05/09/2007
Last Update Date : 09/11/2025

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