Healthcare Provider Details

I. General information

NPI: 1093352650
Provider Name (Legal Business Name): MAYOLA G SALGADO-CISNEROS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3136 CROSS CANYON LN
GRAND JUNCTION CO
81504-6268
US

IV. Provider business mailing address

3136 CROSS CANYON LN
GRAND JUNCTION CO
81504-6268
US

V. Phone/Fax

Practice location:
  • Phone: 719-290-8081
  • Fax:
Mailing address:
  • Phone: 719-290-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009922480
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: