Organization Name: | CLINICA DR ALFONSO SALAS PC |
NPI Number: | 1265692792 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JANNET DECARDENAS (BILLING MANAGER) |
Mailing Address: | 7734 N 59th Ave Glendale |
State: | AZ US |
Postal Code: | 853017816 |
Phone Number: | 6239312444 |
Fax Number: | 6239311099 |
NPI Enumeration Date: | 06/09/2008 |
NPI Last Update Date: | 09/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 29615 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |