MEDICARE: MR. RODOLFO SALAZAR JR. CM

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1407450083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RODOLFO SALAZAR JR. CM

Provider Business Mailing Address
First Line	:	3121 RED SAILS
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-2121
Country	:	US
Telephone Number	:	915-999-7315
Fax Number	:	915-207-1905

Provider Business Practice Location Address
First Line	:	6044 GATEWAY BLVD EAST
Second Line	:	SUITE 444
City	:	EL PASO
State	:	TX
Zip	:	79905-2035
Country	:	US
Telephone Number	:	915-888-7908
Fax Number	:	915-207-1905

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

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	07/14/2022

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