Provider Demographics
NPI:1851381495
Name:SALAZAR, FERNANDO GUILLERMO (MD)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:GUILLERMO
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MD
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 1169
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1169
Mailing Address - Country:US
Mailing Address - Phone:787-833-1090
Mailing Address - Fax:787-833-1090
Practice Address - Street 1:DE DIEGO # 64 ESTE
Practice Address - Street 2:CONDOMINIO CENTRO PLAZA OFFICE #3-4
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-1090
Practice Address - Fax:787-833-1090
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4785207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D08753Medicare ID - Type Unspecified