Healthcare Provider Details

I. General information

NPI: 1043027220
Provider Name (Legal Business Name): JARRELLE EVANGELISTA SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 HOWE AVE STE 113
SACRAMENTO CA
95825-3365
US

IV. Provider business mailing address

PO BOX 811
RANCHO CORDOVA CA
95741-0811
US

V. Phone/Fax

Practice location:
  • Phone: 916-272-1920
  • Fax:
Mailing address:
  • Phone: 916-306-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162924
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: