Healthcare Provider Details

I. General information

NPI: 1336839877
Provider Name (Legal Business Name): EUNICE R SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE
ALBUQUERQUE NM
87112-1273
US

IV. Provider business mailing address

3241 CLEAR SKY ST SW
LOS LUNAS NM
87031-6414
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-0104
  • Fax:
Mailing address:
  • Phone: 505-331-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2022-0204
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: