Provider Demographics
NPI:1336474618
Name:ZALDIVAR-SALAZAR, MAIRELIS
Entity Type:Individual
Prefix:MRS
First Name:MAIRELIS
Middle Name:
Last Name:ZALDIVAR-SALAZAR
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 1:10008 W BLOCH RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4446
Mailing Address - Country:US
Mailing Address - Phone:602-621-2931
Mailing Address - Fax:623-398-8666
Practice Address - Street 1:10008 W BLOCH RD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-4446
Practice Address - Country:US
Practice Address - Phone:602-621-2931
Practice Address - Fax:623-398-8666
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL7702 H261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27-0278545Medicaid
AZALH7198Medicaid