Provider Demographics
NPI:1295209229
Name:PENA SALAZAR, SUSANA (SA-C)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:PENA SALAZAR
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 COVE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3082
Mailing Address - Country:US
Mailing Address - Phone:832-769-7815
Mailing Address - Fax:
Practice Address - Street 1:12507 COVE LANDING DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3082
Practice Address - Country:US
Practice Address - Phone:832-769-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18-504246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant