Healthcare Provider Details

I. General information

NPI: 1225307895
Provider Name (Legal Business Name): MARIA JESSIE SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 W 6TH ST FL 2
SAN PEDRO CA
90731-2987
US

IV. Provider business mailing address

28364 S WESTERN AVE # 480
RANCHO PALOS VERDES CA
90275-1434
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-6100
  • Fax:
Mailing address:
  • Phone: 310-344-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1418371225
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: