Provider Demographics
NPI:1669896023
Name:SALAZAR, COLEEN RAE (IBCLC)
Entity type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:RAE
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W NEWTON CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8050
Mailing Address - Country:US
Mailing Address - Phone:559-697-5721
Mailing Address - Fax:559-372-7911
Practice Address - Street 1:2740 W NEWTON CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8050
Practice Address - Country:US
Practice Address - Phone:559-697-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-30679174N00000X
CA752176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN