Healthcare Provider Details

I. General information

NPI: 1164994349
Provider Name (Legal Business Name): CARINA GARNICA SALAIZA MSW,ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 VENEMAN AVE STE A100
MODESTO CA
95356-0639
US

IV. Provider business mailing address

PO BOX 688 2937 VENEMAN AVE SUITE A100 MODESTO CA 95356
MODESTO CA
95353-0688
US

V. Phone/Fax

Practice location:
  • Phone: 209-648-9661
  • Fax:
Mailing address:
  • Phone: 209-604-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112267
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number112267
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: