Healthcare Provider Details

I. General information

NPI: 1104095025
Provider Name (Legal Business Name): JUDITH L SALZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 W CHEYENNE AVE STE 208
NORTH LAS VEGAS NV
89032-8901
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 702-648-8116
  • Fax: 702-648-8259
Mailing address:
  • Phone: 800-232-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number9809
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: