Provider Demographics
NPI:1225306624
Name:SALAZAR, ADA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ADA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-1220
Mailing Address - Country:US
Mailing Address - Phone:213-342-0131
Mailing Address - Fax:213-342-0256
Practice Address - Street 1:1910 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1220
Practice Address - Country:US
Practice Address - Phone:213-342-0131
Practice Address - Fax:213-342-0256
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW33056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7782Medicaid