Provider Demographics
NPI:1720656218
Name:SALAZAR, ANGELICA TERESA (NP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:TERESA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HEFFERNAN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4718
Mailing Address - Country:US
Mailing Address - Phone:760-270-9126
Mailing Address - Fax:
Practice Address - Street 1:420 HEFFERNAN AVE STE D
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4718
Practice Address - Country:US
Practice Address - Phone:760-270-9126
Practice Address - Fax:760-890-0005
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA364880889Medicaid
CA364880889OtherPREFERRED PROVIDER ORGANIZATION