Provider Demographics
NPI:1881155513
Name:SALAS, NATHALIE ALICIA
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:ALICIA
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 1:2160 FLETCHER PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2117
Mailing Address - Country:US
Mailing Address - Phone:619-387-8272
Mailing Address - Fax:619-314-5161
Practice Address - Street 1:2160 FLETCHER PKWY STE 105
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2117
Practice Address - Country:US
Practice Address - Phone:619-387-8272
Practice Address - Fax:619-314-5161
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 225400000X, 390200000X
CA153804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner