Provider Demographics
NPI:1962693713
Name:PALOMARES, SALVADOR (MFT)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:PALOMARES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-0934
Mailing Address - Country:US
Mailing Address - Phone:510-374-6140
Mailing Address - Fax:
Practice Address - Street 1:13201 SAN PABLO AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3958
Practice Address - Country:US
Practice Address - Phone:510-451-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist