Basic Information
| Provider Information | |||||||||
| NPI: | 1841473071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 SUNSET DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950235606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316362640 | ||||||||
| FaxNumber: | 8316362609 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W LEA ST | ||||||||
| Address2: | |||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882405110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753910270 | ||||||||
| FaxNumber: | 5753910271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 06/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A102245 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD20080080 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.