Provider Demographics
NPI:1558123877
Name:CHAMALE SALAZAR, JULIE GARDENIA
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:GARDENIA
Last Name:CHAMALE SALAZAR
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 1:4603 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5111
Mailing Address - Country:US
Mailing Address - Phone:323-286-5450
Mailing Address - Fax:
Practice Address - Street 1:1605 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3808
Practice Address - Country:US
Practice Address - Phone:323-433-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst