Provider Demographics
NPI:1639269145
Name:SALVADOR, CAZ LOUISE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CAZ
Middle Name:LOUISE
Last Name:SALVADOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:9507 HOSPITAL AVENUE
Practice Address - Street 2:RIVERSIDE SHORE MEM HOSPITAL
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413-0017
Practice Address - Country:US
Practice Address - Phone:757-414-8004
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166987367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA5831OtherRAILROAD CARRIER
DE1000023500Medicaid
DE1000023500Medicaid
DEP42760Medicare UPIN
VA012561N28Medicare PIN