Provider Demographics
NPI:1356054720
Name:SALAZAR MIRALLES, SOFIA ISABELA
Entity type:Individual
Prefix:
First Name:SOFIA ISABELA
Middle Name:
Last Name:SALAZAR MIRALLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 66TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4875
Mailing Address - Country:US
Mailing Address - Phone:806-630-0126
Mailing Address - Fax:806-722-5225
Practice Address - Street 1:4601 66TH ST STE E
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4875
Practice Address - Country:US
Practice Address - Phone:806-630-0126
Practice Address - Fax:806-722-5225
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96599101YP2500X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional