Provider Demographics
NPI:1073161923
Name:SALAZAR-HOSPEDALES, MARISSA JASMINE
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JASMINE
Last Name:SALAZAR-HOSPEDALES
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 1:22004 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1621
Mailing Address - Country:US
Mailing Address - Phone:718-712-3358
Mailing Address - Fax:
Practice Address - Street 1:22004 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1621
Practice Address - Country:US
Practice Address - Phone:718-712-3358
Practice Address - Fax:888-352-0588
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator