Healthcare Provider Details

I. General information

NPI: 1992397764
Provider Name (Legal Business Name): GINA SALZARULO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W BROOKSIDE AVE
CHERRY VALLEY CA
92223-4073
US

IV. Provider business mailing address

7891 ANGUS WAY
RIVERSIDE CA
92508-6079
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-1631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: