Healthcare Provider Details

I. General information

NPI: 1386945301
Provider Name (Legal Business Name): SELINA SALINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 SIGMA RD 100
DALLAS TX
75244-4421
US

IV. Provider business mailing address

4350 SIGMA RD 100
DALLAS TX
75244-4421
US

V. Phone/Fax

Practice location:
  • Phone: 972-991-6777
  • Fax: 972-991-6361
Mailing address:
  • Phone: 972-991-6777
  • Fax: 972-991-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10-4024
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number10-4024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: