Healthcare Provider Details

I. General information

NPI: 1467283614
Provider Name (Legal Business Name): REBECCA SALAMO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 ARTESIA BLVD STE 320
REDONDO BEACH CA
90278-3282
US

IV. Provider business mailing address

12337 SEAL BEACH BLVD # 1057
SEAL BEACH CA
90740-2708
US

V. Phone/Fax

Practice location:
  • Phone: 424-277-2899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA SALAMO
Title or Position: CEO - OWNER
Credential: MD
Phone: 424-277-2899