Provider Demographics
NPI:1952806648
Name:SALINAS, SERGIO OMAR
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:OMAR
Last Name:SALINAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 E RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-0466
Mailing Address - Country:US
Mailing Address - Phone:956-605-1260
Mailing Address - Fax:
Practice Address - Street 1:2609 NESSUH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-4814
Practice Address - Country:US
Practice Address - Phone:956-630-1116
Practice Address - Fax:956-630-1250
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308437164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse