Provider Demographics
NPI:1912214446
Name:ADELITAS MEDICAL-NWH
Entity Type:Organization
Organization Name:ADELITAS MEDICAL-NWH
Other - Org Name:ADELITAS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-351-9400
Mailing Address - Street 1:610 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-2750
Mailing Address - Country:US
Mailing Address - Phone:214-351-9400
Mailing Address - Fax:214-222-9114
Practice Address - Street 1:610 E JEFFERSON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-2750
Practice Address - Country:US
Practice Address - Phone:214-351-9400
Practice Address - Fax:214-222-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219463101Medicaid
TX219463102Medicaid