Provider Demographics
NPI:1710597000
Name:SALAZAR SANCHEZ, GUILLERMO
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:SALAZAR SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13796 SW 155TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1147
Mailing Address - Country:US
Mailing Address - Phone:786-803-2824
Mailing Address - Fax:
Practice Address - Street 1:13796 SW 155TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1147
Practice Address - Country:US
Practice Address - Phone:786-803-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-118432106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty