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General NPI Number Information
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NPI Number | 1093273013
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Entity Type | Individual
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Provider Name | SUSANA ORTIZ SALGADO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 22996 EL TORO RD STE 103
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City | LAKE FOREST
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State | CA
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Zip | 92630-4961
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Country | US
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Telephone | 949-942-1991
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Fax | 949-942-1969
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Provider Business Mailing Address
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Address Line | 22996 EL TORO RD STE 109
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City | LAKE FOREST
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State | CA
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Zip | 92630-4961
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY22980
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License Number State | CA
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