Healthcare Provider Details

I. General information

NPI: 1245652593
Provider Name (Legal Business Name): DR. PAUL GREGORY SALAZAR I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205B SCHOOL OF MINES RD
SOCORRO NM
87801-4545
US

IV. Provider business mailing address

205B SCHOOL OF MINES RD
SOCORRO NM
87801-4545
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: