Provider Demographics
NPI:1497092506
Name:SALAZARS HEALTH IDEA, PA
Entity Type:Organization
Organization Name:SALAZARS HEALTH IDEA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:UBALDO
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:SALAZAR ALAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-622-6394
Mailing Address - Street 1:27271 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2748
Mailing Address - Country:US
Mailing Address - Phone:210-369-4667
Mailing Address - Fax:210-369-4673
Practice Address - Street 1:615 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-5234
Practice Address - Country:US
Practice Address - Phone:210-369-4667
Practice Address - Fax:210-369-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX313695Medicare PIN