MEDICARE: VALENTINO SALAZAR INDEPENDENT DUTY HM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1407007271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENTINO SALAZAR INDEPENDENT DUTY HM

Provider Business Mailing Address
First Line	:	COMMANDING OFFICER, USS ALBUQUERQUE (SSN 706)
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96660-2386
Country	:	US
Telephone Number	:	619-553-7293
Fax Number	:	619-553-7293

Provider Business Practice Location Address
First Line	:	USS ALBUQUERQUE SSN 706
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96660-2386
Country	:	US
Telephone Number	:	619-553-7293
Fax Number	:	619-553-7293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	05/05/2010

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