Healthcare Provider Details

I. General information

NPI: 1801269691
Provider Name (Legal Business Name): JENNIFER SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 PHILADELPHIA CT
RIVERSIDE CA
92503-5026
US

IV. Provider business mailing address

3545 PHILADELPHIA CT
RIVERSIDE CA
92503-5026
US

V. Phone/Fax

Practice location:
  • Phone: 781-558-0484
  • Fax:
Mailing address:
  • Phone: 781-558-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: