Basic Information
| Provider Information | |||||||||
| NPI: | 1386257079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | STARLA VANESSA | ||||||||
| MiddleName: | BENDANA | ||||||||
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| Credential: | MSW, ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2011 | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917782011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264558527 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10603 DOWNEY AVE | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902413426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626222268 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2020 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW87801 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.