Provider Demographics
NPI:1639488802
Name:TAN, SALINAS (LCSW 80386)
Entity Type:Individual
Prefix:
First Name:SALINAS
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:LCSW 80386
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 S VERMONT AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1349
Mailing Address - Country:US
Mailing Address - Phone:213-804-9421
Mailing Address - Fax:
Practice Address - Street 1:695 S VERMONT AVE FL 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1349
Practice Address - Country:US
Practice Address - Phone:213-804-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical