Provider Demographics
NPI:1639623150
Name:SALAZAR, ROCIO ADA
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:ADA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROCIO
Other - Middle Name:ADA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11629 GROTTO BAY CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1089
Mailing Address - Country:US
Mailing Address - Phone:915-861-0109
Mailing Address - Fax:
Practice Address - Street 1:11629 GROTTO BAY CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1089
Practice Address - Country:US
Practice Address - Phone:915-861-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35595126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant