Healthcare Provider Details

I. General information

NPI: 1073424248
Provider Name (Legal Business Name): JACKELIN SALGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W 99TH ST
LOS ANGELES CA
90044-4606
US

IV. Provider business mailing address

722 W 99TH ST
LOS ANGELES CA
90044-4606
US

V. Phone/Fax

Practice location:
  • Phone: 323-408-3254
  • Fax:
Mailing address:
  • Phone: 323-408-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: