Healthcare Provider Details

I. General information

NPI: 1588588099
Provider Name (Legal Business Name): GISELLE VANESSA SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10378 ORCHARD AVE
ADELANTO CA
92301-3515
US

IV. Provider business mailing address

3333 CONCOURS STE 4102
ONTARIO CA
91764-6564
US

V. Phone/Fax

Practice location:
  • Phone: 760-508-6510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: