Healthcare Provider Details

I. General information

NPI: 1528560166
Provider Name (Legal Business Name): DAISY FUENTES-SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LOWER RAGSDALE DR
MONTEREY CA
93940
US

IV. Provider business mailing address

117 MONTEBELLO DR
WATSONVILLE CA
95076-6005
US

V. Phone/Fax

Practice location:
  • Phone: 831-642-6201
  • Fax:
Mailing address:
  • Phone: 831-566-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112203
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: