Provider Demographics
NPI:1871759514
Name:SALGADO, GLORIA CONSUELO (MA)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:CONSUELO
Last Name:SALGADO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3413
Mailing Address - Country:US
Mailing Address - Phone:323-953-7356
Mailing Address - Fax:323-661-7306
Practice Address - Street 1:3910 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3413
Practice Address - Country:US
Practice Address - Phone:323-953-7356
Practice Address - Fax:323-661-7306
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CALMFT87053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner