1811159221 NPI number — DR. CLINT HAROLD SALO DO

Table of content: DR. CLINT HAROLD SALO DO (NPI 1811159221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811159221 NPI number — DR. CLINT HAROLD SALO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALO
Provider First Name:
CLINT
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811159221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92623-8228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-955-2101
Provider Business Mailing Address Fax Number:
949-390-6519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17782 COWAN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92614-6030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-722-7118
Provider Business Practice Location Address Fax Number:
949-722-7119
Provider Enumeration Date:
06/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  20A12121 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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