Healthcare Provider Details

I. General information

NPI: 1598534984
Provider Name (Legal Business Name): DUSTIN S SALAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1410
ALBUQUERQUE NM
87102-5333
US

IV. Provider business mailing address

500 MARQUETTE AVE NW STE 1410
ALBUQUERQUE NM
87102-5333
US

V. Phone/Fax

Practice location:
  • Phone: 505-901-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0877
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: