Healthcare Provider Details

I. General information

NPI: 1760617336
Provider Name (Legal Business Name): FRANK R SALAZAR RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8553 W ODGEN AVE UNIT 2
LYONS IL
60534-1078
US

IV. Provider business mailing address

PO BOX 318
LYONS IL
60534-0318
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-9800
  • Fax: 708-442-9889
Mailing address:
  • Phone: 708-442-9800
  • Fax: 708-442-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number194.003094
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: