Provider Demographics
NPI:1043027220
Name:SALAZAR, JARRELLE EVANGELISTA
Entity type:Individual
Prefix:
First Name:JARRELLE
Middle Name:EVANGELISTA
Last Name:SALAZAR
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 1:4234 MUSTIC WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-3032
Mailing Address - Country:US
Mailing Address - Phone:916-801-6802
Mailing Address - Fax:
Practice Address - Street 1:3960 INDUSTRIAL BLVD # 600
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3496
Practice Address - Country:US
Practice Address - Phone:916-752-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health