Healthcare Provider Details

I. General information

NPI: 1083174551
Provider Name (Legal Business Name): SALVADOR ROLAND MAFFEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 MAIN ST # MCE1420
HOUSTON TX
77030-2351
US

IV. Provider business mailing address

6651 MAIN ST # MCE1420
HOUSTON TX
77030-2351
US

V. Phone/Fax

Practice location:
  • Phone: 832-826-6230
  • Fax: 832-826-4252
Mailing address:
  • Phone: 832-826-6230
  • Fax: 832-825-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberT5973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: