Healthcare Provider Details

I. General information

NPI: 1215277033
Provider Name (Legal Business Name): MIGUEL SALAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 2, STE 300
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

5709 WHITEBROOK DR
AUSTIN TX
78724-3448
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax:
Mailing address:
  • Phone: 512-297-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: