Provider Demographics
NPI:1174269716
Name:SALAZAR, EDGAR
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDGAR
Other - Middle Name:
Other - Last Name:SALAZAR VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:634 N FARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3008
Mailing Address - Country:US
Mailing Address - Phone:510-395-2420
Mailing Address - Fax:
Practice Address - Street 1:2731 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2449
Practice Address - Country:US
Practice Address - Phone:559-233-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17275101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)