Basic Information
| Provider Information | |||||||||
| NPI: | 1598298168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | VANESSA | ||||||||
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| Credential: | CATC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2330 BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900572220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132646124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11315 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902623007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105375883 | ||||||||
| FaxNumber: | 3105875587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.