Healthcare Provider Details

I. General information

NPI: 1255240123
Provider Name (Legal Business Name): JUAN MARTIN SALAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 EXECUTIVE CENTER DR STE 255
AUSTIN TX
78731-1633
US

IV. Provider business mailing address

3029 HILL ST
ROUND ROCK TX
78664-5789
US

V. Phone/Fax

Practice location:
  • Phone: 737-346-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: