Healthcare Provider Details

I. General information

NPI: 1336474618
Provider Name (Legal Business Name): MRS. MAIRELIS ZALDIVAR-SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10008 W BLOCH RD
TOLLESON AZ
85353-4446
US

IV. Provider business mailing address

10008 W BLOCH RD
TOLLESON AZ
85353-4446
US

V. Phone/Fax

Practice location:
  • Phone: 602-621-2931
  • Fax: 623-398-8666
Mailing address:
  • Phone: 602-621-2931
  • Fax: 623-398-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberAL7702 H
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: