Provider Demographics
NPI:1649950643
Name:SALAZAR, AMY DENISE (SUDRC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DENISE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13061 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1116
Mailing Address - Country:US
Mailing Address - Phone:714-818-9321
Mailing Address - Fax:
Practice Address - Street 1:218 E COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1911
Practice Address - Country:US
Practice Address - Phone:562-243-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15877101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)