Healthcare Provider Details

I. General information

NPI: 1710055686
Provider Name (Legal Business Name): NANCY LUGO SALAS MSCCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12253 DELACROIX DR
EL PASO TX
79936-0248
US

IV. Provider business mailing address

12253 DELACROIX DR
EL PASO TX
79936-0248
US

V. Phone/Fax

Practice location:
  • Phone: 915-525-3269
  • Fax: 915-849-9604
Mailing address:
  • Phone: 915-525-3269
  • Fax: 915-849-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18000
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3930
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: