Healthcare Provider Details

I. General information

NPI: 1285984351
Provider Name (Legal Business Name): ASHLEY NICOLE SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10704 MIERA DR NW
ALBUQUERQUE NM
87114-5696
US

IV. Provider business mailing address

10704 MIERA DR NW
ALBUQUERQUE NM
87114-5696
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-3706
  • Fax:
Mailing address:
  • Phone: 505-261-3706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: