Provider Demographics
NPI:1861298093
Name:SALAZAR, DAVID AGUNDEZ
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:AGUNDEZ
Last Name:SALAZAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 S KANSAS
Mailing Address - Street 2:
Mailing Address - City:GUERNSEY
Mailing Address - State:WY
Mailing Address - Zip Code:82214-5082
Mailing Address - Country:US
Mailing Address - Phone:949-505-4098
Mailing Address - Fax:
Practice Address - Street 1:248 S KANSAS
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214-5082
Practice Address - Country:US
Practice Address - Phone:949-505-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health