Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 4301406855 | MI |
N | 2080P0201X | Pediatric Allergist | 4301406855 | MI |
NPI | 1962588681 |
---|---|
Provider Name | Dr. Reina O Salazar |
First Address | Eastpointe, MI 48021 |
Second Address | Saint Clair Shores, MI 48080-1968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E85474 | (02) |