Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CO | |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 5630 | CO |
NPI | 1003018623 |
---|---|
Provider Name | Raymond Moses Salazar |
First Address | Alamosa, CO 81101-3578 |
Second Address | Alamosa, CO 81101-3578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 11/02/2019 |