Provider Demographics
NPI:1972146520
Name:CHIRINOS SALAZAR, RAFAEL HUMBERTO (SA-C)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:HUMBERTO
Last Name:CHIRINOS SALAZAR
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PELHAM RD APT 62
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3138
Mailing Address - Country:US
Mailing Address - Phone:864-363-6971
Mailing Address - Fax:
Practice Address - Street 1:300 PELHAM RD APT 62
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3138
Practice Address - Country:US
Practice Address - Phone:864-363-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19-418246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant