Healthcare Provider Details

I. General information

NPI: 1528041290
Provider Name (Legal Business Name): KIMBERLY COLLEEN SALAZAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2005
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR BLDG 7505
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7129
  • Fax:
Mailing address:
  • Phone: 210-916-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL8756
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberL8756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: