Provider Demographics
NPI:1063546786
Name:ARDON, SALVADOR (PHD,LMFT)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:ARDON
Suffix:
Gender:M
Credentials:PHD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 S GLENCROFT RD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5163
Mailing Address - Country:US
Mailing Address - Phone:626-852-9695
Mailing Address - Fax:
Practice Address - Street 1:7777-B MILLIKEN AVE.
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-944-3559
Practice Address - Fax:909-944-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist