Healthcare Provider Details

I. General information

NPI: 1184979445
Provider Name (Legal Business Name): BETTINA A SALINAS M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E OAK HILL AVE
KNOXVILLE TN
37917-5435
US

IV. Provider business mailing address

501 E OAK HILL AVE
KNOXVILLE TN
37917-5435
US

V. Phone/Fax

Practice location:
  • Phone: 865-230-0674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberML19962
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number4316
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: