Provider Demographics
NPI:1821346784
Name:SALAZAR-HAGERTY, BERTA ALICIA
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:ALICIA
Last Name:SALAZAR-HAGERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERTA
Other - Middle Name:ALICIA
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2060 CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097
Mailing Address - Country:US
Mailing Address - Phone:530-841-4100
Mailing Address - Fax:
Practice Address - Street 1:2060 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-841-4100
Practice Address - Fax:530-841-4841
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator