Provider Demographics
NPI:1497155196
Name:SALAZAR, ROGER (HIS)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6468 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4842
Mailing Address - Country:US
Mailing Address - Phone:361-814-3487
Mailing Address - Fax:361-814-3490
Practice Address - Street 1:2012 N. SAINT MARY'S ST.
Practice Address - Street 2:STE. B
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-2409
Practice Address - Country:US
Practice Address - Phone:361-354-5455
Practice Address - Fax:361-354-5466
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80577237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist