Basic Information
| Provider Information | |||||||||
| NPI: | 1477980779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 CORRIZ DR SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871218311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058360623 | ||||||||
| FaxNumber: | 5058489468 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 CORRIZ DR SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871218311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058360623 | ||||||||
| FaxNumber: | 5058489468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2013 | ||||||||
| LastUpdateDate: | 10/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | M-07837 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.