Provider Demographics
NPI:1346338555
Name:SALAZAR, ROMAN (LADAC)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LUCIA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3000
Mailing Address - Country:US
Mailing Address - Phone:505-471-4985
Mailing Address - Fax:505-471-6084
Practice Address - Street 1:4100 LUCIA LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3000
Practice Address - Country:US
Practice Address - Phone:505-471-4985
Practice Address - Fax:505-471-6084
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3691101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)