Basic Information
| Provider Information | |||||||||
| NPI: | 1033463708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR HERNANDEZ | ||||||||
| FirstName: | HADEILY | ||||||||
| MiddleName: | EVANGELINA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1690 | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463521690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193262461 | ||||||||
| FaxNumber: | 2193256439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1509 STATE ST | ||||||||
| Address2: | |||||||||
| City: | LA PORTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463503115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193243431 | ||||||||
| FaxNumber: | 2193623802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 01074872A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 201297410 | 05 | IN | MEDICAID | 151020036 | 01 | IN | MEDICARE PTAN | OTHER |