Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY22980 | CA |
NPI | 1093273013 |
---|---|
Provider Name | Dr. Susana Ortiz Salgado |
First Address | Lake Forest, CA 92630-4961 |
Second Address | Lake Forest, CA 92630-4961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2019 |
Last Update Date | 08/03/2019 |