Provider Demographics
NPI:1225307895
Name:SALAS, MARIA JESSIE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JESSIE
Last Name:SALAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 W 6TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3561
Mailing Address - Country:US
Mailing Address - Phone:310-519-6100
Mailing Address - Fax:310-519-6100
Practice Address - Street 1:1360 W 6TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3561
Practice Address - Country:US
Practice Address - Phone:310-519-6100
Practice Address - Fax:310-519-6100
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner