Healthcare Provider Details

I. General information

NPI: 1649889890
Provider Name (Legal Business Name): MS. MONICA ANN SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 S YULE AVE # 303
CHARLOTTE TX
78011-3484
US

IV. Provider business mailing address

142 S YULE AVE # 303
CHARLOTTE TX
78011-3484
US

V. Phone/Fax

Practice location:
  • Phone: 210-636-6190
  • Fax:
Mailing address:
  • Phone: 210-636-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number203517
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: