Provider Demographics
NPI:1679897003
Name:SALAZAR, CARL (LMT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ARVADA AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1101
Mailing Address - Country:US
Mailing Address - Phone:505-843-9021
Mailing Address - Fax:
Practice Address - Street 1:8625 GOLF COURSE RD NW STE A-2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5114
Practice Address - Country:US
Practice Address - Phone:505-899-6600
Practice Address - Fax:505-899-3262
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT3654174400000X
NM3654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist