Provider Demographics
NPI:1841473071
Name:SALAZAR, JESSIE A (MD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:A
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5606
Mailing Address - Country:US
Mailing Address - Phone:831-636-2640
Mailing Address - Fax:831-636-2609
Practice Address - Street 1:200 W LEA ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5110
Practice Address - Country:US
Practice Address - Phone:575-391-0270
Practice Address - Fax:575-391-0271
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102245207Q00000X
NMMD20080080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine