MEDICARE: MRS. BERENICE SALVATIERRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	28766	CA
2	1041C0700X	Clinical Social Worker	69667	CA

General Provider Information

NPI Number	:	1902948755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BERENICE SALVATIERRA

Provider Business Mailing Address
First Line	:	2500 E FOOTHILL BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3464
Country	:	US
Telephone Number	:	626-564-1613
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 E FOOTHILL BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3464
Country	:	US
Telephone Number	:	626-564-1613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	01/28/2016

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