Provider Demographics
NPI:1154474138
Name:SALINAS, CONSUELO VILLARREAL
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:VILLARREAL
Last Name:SALINAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17425 LUCKEY RD
Mailing Address - Street 2:
Mailing Address - City:ATASCOSA
Mailing Address - State:TX
Mailing Address - Zip Code:78002-5563
Mailing Address - Country:US
Mailing Address - Phone:210-622-9033
Mailing Address - Fax:210-622-3156
Practice Address - Street 1:17425 LUCKEY RD
Practice Address - Street 2:
Practice Address - City:ATASCOSA
Practice Address - State:TX
Practice Address - Zip Code:78002-5563
Practice Address - Country:US
Practice Address - Phone:210-622-9033
Practice Address - Fax:210-622-3156
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117955310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility