Healthcare Provider Details

I. General information

NPI: 1396468443
Provider Name (Legal Business Name): JUAN CARLOS PALLARES-SALAZAR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

2942 N 24TH ST STE 115
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 602-518-0773
  • Fax:
Mailing address:
  • Phone: 602-518-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number232109
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: