Healthcare Provider Details

I. General information

NPI: 1518687367
Provider Name (Legal Business Name): SAL PSYCHIATRY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 FIRESTONE BLVD STE 310
NORWALK CA
90650-4397
US

IV. Provider business mailing address

12440 FIRESTONE BLVD STE 310
NORWALK CA
90650-4397
US

V. Phone/Fax

Practice location:
  • Phone: 562-280-7176
  • Fax: 562-262-0735
Mailing address:
  • Phone: 562-280-7176
  • Fax: 562-262-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: HASMIK JASMINE AVETISYAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 818-469-9099