Provider Demographics
NPI:1568941490
Name:SALGADO, GENESIS
Entity Type:Individual
Prefix:MS
First Name:GENESIS
Middle Name:
Last Name:SALGADO
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8160
Mailing Address - Fax:956-362-8169
Practice Address - Street 1:1100 E DOVE AVE STE 400
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4684
Practice Address - Country:US
Practice Address - Phone:956-362-8160
Practice Address - Fax:956-362-8169
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily