Provider Demographics
NPI:1659380061
Name:SALAZAR, CLARA ILIANA (PA-C)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:ILIANA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24826 BLANE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2713
Mailing Address - Country:US
Mailing Address - Phone:832-741-9447
Mailing Address - Fax:832-437-1776
Practice Address - Street 1:8345 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-2022
Practice Address - Country:US
Practice Address - Phone:713-973-0812
Practice Address - Fax:713-973-6710
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA LICENSEOtherPA04875
TX8L21247Medicare PIN