Provider Demographics
NPI:1396740155
Name:SANCHEZ-SALAZAR, MARITZA
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:SANCHEZ-SALAZAR
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 1:1578 N HWY 89 STE 1
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-7624
Mailing Address - Country:US
Mailing Address - Phone:928-237-4061
Mailing Address - Fax:
Practice Address - Street 1:1578 N HWY 89 STE 1
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-7624
Practice Address - Country:US
Practice Address - Phone:928-237-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444951Medicaid