Provider Demographics
NPI:1265701718
Name:SALAZAR, CARLOS GUSTAVO (MD CSA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:GUSTAVO
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MD CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 691789
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1789
Mailing Address - Country:US
Mailing Address - Phone:832-237-5656
Mailing Address - Fax:832-237-5655
Practice Address - Street 1:8203 WILLOW PLACE SOUTH
Practice Address - Street 2:SUITE 419
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5655
Practice Address - Country:US
Practice Address - Phone:832-237-5656
Practice Address - Fax:832-237-5655
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03-138208600000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery