Healthcare Provider Details

I. General information

NPI: 1942706494
Provider Name (Legal Business Name): ERIC S SALAZAR DOM,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9798 COORS BLVD NW # BUIDINGD
ALBUQUERQUE NM
87114-6131
US

IV. Provider business mailing address

6115 WOODHOLLOW PL NW
ALBUQUERQUE NM
87120-2620
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-4774
  • Fax:
Mailing address:
  • Phone: 505-228-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1220
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: