MEDICARE: JOSE A. SALAZAR LCSW

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	104100000X	Social Worker	61161	TX

General Provider Information

NPI Number	:	1689103590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE A. SALAZAR LCSW

Provider Business Mailing Address
First Line	:	PO BOX 4463
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78540-4463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 N 22ND ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4167
Country	:	US
Telephone Number	:	956-354-7077
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	01/29/2020

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