Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 21354 | TX |
NPI | 1871623389 |
---|---|
Provider Name | Dr. Rolando Salazar |
First Address | San Antonio, TX 78229-6044 |
Second Address | San Antonio, TX 78229-6044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159348501 | (05) | TX |
159348509 | (05) | TX |
U97934 | (02) | TX |