Provider Demographics
NPI:1306195789
Name:SALGUERO, JENNIFER (D,O)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SALGUERO
Suffix:
Gender:F
Credentials:D,O
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ELLEN
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8415 PETALUMA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2695
Mailing Address - Country:US
Mailing Address - Phone:505-463-1560
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR
Practice Address - Street 2:KIRTLAND AFB
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87117
Practice Address - Country:US
Practice Address - Phone:505-846-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1083207Q00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program