Provider Demographics
NPI:1043583883
Name:SALGADO, MAVIS
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:SALGADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 S PECOS RD
Mailing Address - Street 2:BLGD G STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-5428
Mailing Address - Country:US
Mailing Address - Phone:702-538-9474
Mailing Address - Fax:
Practice Address - Street 1:5860 S PECOS RD
Practice Address - Street 2:BLGD G STE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5428
Practice Address - Country:US
Practice Address - Phone:702-538-9474
Practice Address - Fax:702-834-8437
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health