Healthcare Provider Details

I. General information

NPI: 1023946902
Provider Name (Legal Business Name): ASTRID SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 PENN CT UNIT B
CRYSTAL LAKE IL
60014-2710
US

IV. Provider business mailing address

1670 PENN CT UNIT B
CRYSTAL LAKE IL
60014-2710
US

V. Phone/Fax

Practice location:
  • Phone: 815-271-1664
  • Fax:
Mailing address:
  • Phone: 815-271-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberS42601475904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: