MEDICARE: DR. A JOSEPH SALAIS PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY12750	CA

General Provider Information

NPI Number	:	1700889466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. A JOSEPH SALAIS PH.D.

Provider Business Mailing Address
First Line	:	10400 W OVERLAND RD #214
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	925-942-7110
Fax Number	:	208-297-6551

Provider Business Practice Location Address
First Line	:	10400 W OVERLAND RD #214
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1433
Country	:	US
Telephone Number	:	925-942-7110
Fax Number	:	208-297-6551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/25/2025

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