Healthcare Provider Details

I. General information

NPI: 1679897003
Provider Name (Legal Business Name): CARL SALAZAR LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2010
Last Update Date: 03/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 GOLF COURSE RD NW STE A-2
ALBUQUERQUE NM
87114-5114
US

IV. Provider business mailing address

219 ARVADA AVE NE
ALBUQUERQUE NM
87102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-6600
  • Fax: 505-899-3262
Mailing address:
  • Phone: 505-843-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLMT3654
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3654
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: