Provider Demographics
NPI:1275351439
Name:SALVATORE, MICHAEL KIYOSHI
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KIYOSHI
Last Name:SALVATORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 HUNTINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5971
Mailing Address - Country:US
Mailing Address - Phone:415-812-0890
Mailing Address - Fax:
Practice Address - Street 1:1486 HUNTINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5971
Practice Address - Country:US
Practice Address - Phone:415-812-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT148153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health