Healthcare Provider Details

I. General information

NPI: 1700484607
Provider Name (Legal Business Name): VALERIE CELINA SALAZAR COA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 S WADSWORTH BLVD UNIT G207
DENVER CO
80123-1389
US

IV. Provider business mailing address

4760 S WADSWORTH BLVD UNIT G207
DENVER CO
80123-1389
US

V. Phone/Fax

Practice location:
  • Phone: 303-332-1425
  • Fax:
Mailing address:
  • Phone: 303-332-1425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number196836
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: