1922199280 NPI number — MR. JOE L SALAZAR RCP,CRT

Table of content: MR. JOE L SALAZAR RCP,CRT (NPI 1922199280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922199280 NPI number — MR. JOE L SALAZAR RCP,CRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALAZAR
Provider First Name:
JOE
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RCP,CRT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922199280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 PINTURA CR WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92264-6801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-409-7629
Provider Business Mailing Address Fax Number:
760-322-2088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
897 WEST VALLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-254-2780
Provider Business Practice Location Address Fax Number:
909-254-2777
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)