Provider Demographics
NPI:1538284997
Name:SALAS, GENEETA KALIAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GENEETA
Middle Name:KALIAH
Last Name:SALAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21081 S WESTERN AVE STE 295
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1707
Mailing Address - Country:US
Mailing Address - Phone:310-533-6611
Mailing Address - Fax:310-787-9035
Practice Address - Street 1:21081 S WESTERN AVE STE 295
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1707
Practice Address - Country:US
Practice Address - Phone:310-533-6611
Practice Address - Fax:310-787-9035
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical