Healthcare Provider Details

I. General information

NPI: 1184142952
Provider Name (Legal Business Name): STEPHANIE SALGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 03/01/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 THE ALAMEDA STE 200
SAN JOSE CA
95126-1459
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax: 408-400-0437
Mailing address:
  • Phone: 916-576-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: