Provider Demographics
NPI:1760600365
Name:SALAZAR, MARTIN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
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 12355
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79768-2355
Mailing Address - Country:US
Mailing Address - Phone:432-550-7991
Mailing Address - Fax:432-362-7282
Practice Address - Street 1:2817 JOHN BEN SHEPPERD PKWY
Practice Address - Street 2:SUITE E13
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8111
Practice Address - Country:US
Practice Address - Phone:432-550-7991
Practice Address - Fax:432-362-7282
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25444103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist