Healthcare Provider Details

I. General information

NPI: 1497152052
Provider Name (Legal Business Name): DEBORAH SALAZAR D.O.M., LI.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 AVITAL DR NE
ALBUQUERQUE NM
87123-3891
US

IV. Provider business mailing address

401 AVITAL DR NE
ALBUQUERQUE NM
87123-3891
US

V. Phone/Fax

Practice location:
  • Phone: 505-629-5506
  • Fax:
Mailing address:
  • Phone: 505-629-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1128
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: