Provider Demographics
NPI:1386919918
Name:SALAS-OVALLE, BLANCA MONICA
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:MONICA
Last Name:SALAS-OVALLE
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 1:2111 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2529
Mailing Address - Country:US
Mailing Address - Phone:303-312-2217
Mailing Address - Fax:303-293-2309
Practice Address - Street 1:4545 NAVAJO ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2440
Practice Address - Country:US
Practice Address - Phone:303-293-2220
Practice Address - Fax:303-296-8826
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COLPC.0012771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program