Healthcare Provider Details

I. General information

NPI: 1366055816
Provider Name (Legal Business Name): MEGAN SALAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 1ST ST
TULAROSA NM
88352-2702
US

IV. Provider business mailing address

1776 1ST ST APT 3F
ALAMOGORDO NM
88310-5271
US

V. Phone/Fax

Practice location:
  • Phone: 575-585-8817
  • Fax:
Mailing address:
  • Phone: 505-235-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0393
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: