Healthcare Provider Details

I. General information

NPI: 1356178552
Provider Name (Legal Business Name): MAYRA SALINAS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N SAN DIMAS AVE # 219
SAN DIMAS CA
91773-2664
US

IV. Provider business mailing address

9683 BALSA ST
RANCHO CUCAMONGA CA
91730-2215
US

V. Phone/Fax

Practice location:
  • Phone: 909-519-8912
  • Fax:
Mailing address:
  • Phone: 562-774-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: