Healthcare Provider Details

I. General information

NPI: 1346969961
Provider Name (Legal Business Name): SIBELLA SALAZAR LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5442 RESERVE CT NE
RIO RANCHO NM
87144-6380
US

IV. Provider business mailing address

5442 RESERVE CT NE
RIO RANCHO NM
87144-6380
US

V. Phone/Fax

Practice location:
  • Phone: 661-246-6758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1700
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: