=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699768051
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOLANDA MARTINEZ-SALAZAR PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 01/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 SPRUCE ST ESPANOLA MULTI-SPECIALTY CLINIC
-----------------------------------------------------
City | ESPANOLA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-367-0340
-----------------------------------------------------
Fax | 505-367-0346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87125-6666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-923-5356
-----------------------------------------------------
Fax | 505-923-5354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | PA2002-0018
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA2002-0018
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------