Healthcare Provider Details

I. General information

NPI: 1508060187
Provider Name (Legal Business Name): PATRICIA SALAZAR MIRELES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4032 MCDERMOTT RD SUITE 100
PLANO TX
75024-7733
US

IV. Provider business mailing address

4032 MCDERMOTT RD SUITE 100
PLANO TX
75024-7733
US

V. Phone/Fax

Practice location:
  • Phone: 972-769-9000
  • Fax:
Mailing address:
  • Phone: 972-769-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberP0640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: