Provider Demographics
NPI:1407450083
Name:SALAZAR, RODOLFO JR (CM)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:
Last Name:SALAZAR
Suffix:JR
Gender:M
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 RED SAILS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2121
Mailing Address - Country:US
Mailing Address - Phone:915-999-7315
Mailing Address - Fax:915-207-1905
Practice Address - Street 1:6044 GATEWAY BLVD EAST
Practice Address - Street 2:SUITE 444
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2035
Practice Address - Country:US
Practice Address - Phone:915-888-7908
Practice Address - Fax:915-207-1905
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator