Provider Demographics
NPI:1598396947
Name:SALAZAR, JENNIFER KARINA (ACSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KARINA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 THIRD AVE STE 1110
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1350
Mailing Address - Country:US
Mailing Address - Phone:619-934-5770
Mailing Address - Fax:
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8232
Practice Address - Fax:619-542-4060
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2024-11-25
Deactivation Date:2020-02-27
Deactivation Code:
Reactivation Date:2020-03-05
Provider Licenses
StateLicense IDTaxonomies
CA1202401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty