Healthcare Provider Details

I. General information

NPI: 1790011443
Provider Name (Legal Business Name): VELVETTA SALARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5739 CHESLEY AVE
LOS ANGELES CA
90043-2423
US

IV. Provider business mailing address

5731 W SLAUSON AVE STE 210
CULVER CITY CA
90230-6982
US

V. Phone/Fax

Practice location:
  • Phone: 323-299-0822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: