Healthcare Provider Details

I. General information

NPI: 1417670738
Provider Name (Legal Business Name): MIRIAN SALDIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

1242 S TOWNSEND AVE
LOS ANGELES CA
90023-3327
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-2900
  • Fax:
Mailing address:
  • Phone: 323-899-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112186
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112186
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: