Provider Demographics
NPI:1770930414
Name:SALGADO GUTIERREZ, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:SALGADO GUTIERREZ
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 1:6429 COW PEN RD APT U213
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6620
Mailing Address - Country:US
Mailing Address - Phone:786-597-6625
Mailing Address - Fax:
Practice Address - Street 1:11645 NW 91ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4159
Practice Address - Country:US
Practice Address - Phone:786-597-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst