1720090152 NPI number — RAFAEL SALAS MD PA

Table of content: (NPI 1720090152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720090152 NPI number — RAFAEL SALAS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAFAEL SALAS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720090152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 LEVI
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75462-2059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-766-2017
Provider Business Mailing Address Fax Number:
813-933-9585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 CLARKSVILLE ST
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-6097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-739-7830
Provider Business Practice Location Address Fax Number:
903-739-7833
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALAS
Authorized Official First Name:
MARIA ELENA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
813-766-2017

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  ME0047202 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0099NS . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com