MEDICARE: MS. CECILIA S. SALAZAR N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11705	CA

General Provider Information

NPI Number	:	1063416873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CECILIA S. SALAZAR N.P.

Provider Business Mailing Address
First Line	:	6087 N BUNGALOW LN
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1519
Country	:	US
Telephone Number	:	559-435-4871
Fax Number	:	559-453-3566

Provider Business Practice Location Address
First Line	:	3133 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1425
Country	:	US
Telephone Number	:	559-453-8918
Fax Number	:	559-453-3566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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