Provider Demographics
NPI:1952025991
Name:SALAS, VANESSA CRYSTAL
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:CRYSTAL
Last Name:SALAS
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 1:23701 E EAST FORK RD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1477
Mailing Address - Country:US
Mailing Address - Phone:626-250-3290
Mailing Address - Fax:626-910-8198
Practice Address - Street 1:23701 E EAST FORK RD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-1477
Practice Address - Country:US
Practice Address - Phone:626-910-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health