Healthcare Provider Details

I. General information

NPI: 1457148694
Provider Name (Legal Business Name): BIANCA ZAMORANO SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4546 CAMINO DOS VIDAS
LAS CRUCES NM
88012-7604
US

IV. Provider business mailing address

4546 CAMINO DOS VIDAS
LAS CRUCES NM
88012-7604
US

V. Phone/Fax

Practice location:
  • Phone: 520-981-1238
  • Fax:
Mailing address:
  • Phone: 520-981-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number208274
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: