Provider Demographics
NPI:1972733236
Name:SALAZAR, LORELEI LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:LYNN
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 ZURICH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2882
Mailing Address - Country:US
Mailing Address - Phone:210-573-2725
Mailing Address - Fax:
Practice Address - Street 1:6915 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1822
Practice Address - Country:US
Practice Address - Phone:210-341-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00036OtherTEXAS STATE LICENSE