Individual provider Active NPI

Nicolas Dario Canon Salazar, MD

  • Psychiatry Physician
  • San Francisco, CA
National Provider Identifier
1306045281
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A133438 Issued in CA
Practice address
490 Post St Ste 1043
San Francisco, CA 94102-1301
Phone
(925) 282-1778
NPI assigned
Jul 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 0116019347 VA
Psychiatry Physician 2084P0800X A133438 CA Primary

Addresses

Primary practice location

490 Post St Ste 1043
San Francisco, CA 94102-1301

Mailing address

490 Post St Ste 1043
San Francisco, CA 94102-1301
Phone (925) 282-1778

Other practice location 1

7707 Austin Rd
Stockton, CA 95215-8312
Phone (209) 467-8083

Other practice location 2

6200 Wilshire Blvd Ste 1410
Los Angeles, CA 90048-5815
Phone (925) 282-1778

Other practice location 3

1480 64th St Ste 150
Emeryville, CA 94608-2267
Phone (925) 282-1778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220510002200 CA Practitioner - Psychiatry 1052798121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

1480 64TH St
Suite 150
Emeryville, CA 94608-2267
Phone (925) 282-1778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A133438CAMDPsychiatry Physician
0116019347VAMDStudent in an Organized Health Care Education/Training Program

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.nicolascanonsalazar@148377.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1306045281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 POST ST STE 1043",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941021301",
            "telephone_number": "925-282-1778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 POST ST STE 1043",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941021301",
            "telephone_number": "925-282-1778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7707 Austin Rd",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952158312",
            "country_code": "US",
            "telephone_number": "209-467-8083",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6200 Wilshire Blvd Ste 1410",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900485815",
            "country_code": "US",
            "telephone_number": "925-282-1778",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1480 64th St Ste 150",
            "address_purpose": "LOCATION",
            "city": "Emeryville",
            "state": "CA",
            "postal_code": "946082267",
            "country_code": "US",
            "telephone_number": "925-282-1778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANON SALAZAR",
        "first_name": "NICOLAS",
        "middle_name": "DARIO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-12",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116019347",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A133438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.