=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609669001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEISY SALAZAR-MANZO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2025
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12440 FIRESTONE BLVD STE 208
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-9317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-274-7702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7612 STEWART AND GRAY RD
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-4631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-965-7427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | SPA1606
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------