Healthcare Provider Details

I. General information

NPI: 1023715620
Provider Name (Legal Business Name): GISELLE MARIE SALAS MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GISELLE MARIE BOOTH

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 S MOUNTAIN AVE UNIT 1
ONTARIO CA
91762-6129
US

IV. Provider business mailing address

8300 ESTERS BLVD STE 900
IRVING TX
75063-2233
US

V. Phone/Fax

Practice location:
  • Phone: 951-213-1432
  • Fax:
Mailing address:
  • Phone: 415-424-4266
  • Fax: 415-520-6633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108705
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: