Provider Demographics
NPI:1912399700
Name:DE SALAIS, VICTORIA ESTELLA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ESTELLA
Last Name:DE SALAIS
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 1:1309 ZUNI PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2008
Mailing Address - Country:US
Mailing Address - Phone:915-740-7295
Mailing Address - Fax:
Practice Address - Street 1:1309 ZUNI PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2008
Practice Address - Country:US
Practice Address - Phone:915-740-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760651178Medicaid