Basic Information
| Provider Information | |||||||||
| NPI: | 1659585636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | TINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11731 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238329795 | ||||||||
| FaxNumber: | 3238329795 | ||||||||
| Practice Location | |||||||||
| Address1: | 11731 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629468256 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT87255 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.