Healthcare Provider Details

I. General information

NPI: 1134699820
Provider Name (Legal Business Name): LUISA AGUILAR -SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6762 LEXINGTON AVE
LOS ANGELES CA
90038-1217
US

IV. Provider business mailing address

6762 LEXINGTON AVE
LOS ANGELES CA
90038-1217
US

V. Phone/Fax

Practice location:
  • Phone: 323-380-7590
  • Fax:
Mailing address:
  • Phone: 323-787-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97658
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00-85-020-0517
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: