Healthcare Provider Details

I. General information

NPI: 1770059115
Provider Name (Legal Business Name): STEPHANIE SALDIVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

IV. Provider business mailing address

525 W AVENUE P4
PALMDALE CA
93551-3743
US

V. Phone/Fax

Practice location:
  • Phone: 661-341-3037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC19062
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: