Provider Demographics
NPI:1568265668
Name:SALAZAR, EDWARD JOSE
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSE
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 1:4220 E SUMMER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2842
Mailing Address - Country:US
Mailing Address - Phone:714-234-7230
Mailing Address - Fax:714-403-1405
Practice Address - Street 1:TUSTIN ABA SERVICES FOR KIDS - 2201 EAST 4TH STREET,
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:818-602-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1111103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst