1366758393 NPI number — DR. MARLENE B SALAS-PROVANCE PH.D.

Table of content: DR. MARLENE B SALAS-PROVANCE PH.D. (NPI 1366758393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366758393 NPI number — DR. MARLENE B SALAS-PROVANCE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALAS-PROVANCE
Provider First Name:
MARLENE
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1366758393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 30001/MSC 3SPE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88003-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-646-2364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 INTERNATIONAL MALL
Provider Second Line Business Practice Location Address:
SPEECH BLDG. ROOM 158
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88003-1279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-646-3906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2010

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: 235Z00000X , with the licence number:  3836 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com