Provider Demographics
NPI:1346011749
Name:PENA SALAZAR, LEONOR ELENA
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:ELENA
Last Name:PENA 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 1:1750 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2895
Mailing Address - Country:US
Mailing Address - Phone:786-600-0594
Mailing Address - Fax:
Practice Address - Street 1:1750 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2895
Practice Address - Country:US
Practice Address - Phone:786-600-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-596246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant