Provider Demographics
NPI:1821226549
Name:SALAZAR, GRETEL MELISSA (PA)
Entity Type:Individual
Prefix:
First Name:GRETEL
Middle Name:MELISSA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25319 INTERSTATE 45 STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3551
Mailing Address - Country:US
Mailing Address - Phone:832-810-0200
Mailing Address - Fax:888-682-7273
Practice Address - Street 1:25319 INTERSTATE 45 STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3551
Practice Address - Country:US
Practice Address - Phone:832-810-0200
Practice Address - Fax:888-682-7273
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant