Healthcare Provider Details

I. General information

NPI: 1093631533
Provider Name (Legal Business Name): ROWENA SALAZAR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 KEN PRATT BLVD STE 204
LONGMONT CO
80501-6085
US

IV. Provider business mailing address

2101 KEN PRATT BLVD STE 104
LONGMONT CO
80501-6568
US

V. Phone/Fax

Practice location:
  • Phone: 773-354-4285
  • Fax: 773-354-4285
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1630120
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: