Provider Demographics
NPI:1053891234
Name:SALAZAR, MARTHA A (LVN)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:A
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:A
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 W INTERSTATE 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10435 ROYAL EST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3195
Practice Address - Country:US
Practice Address - Phone:726-888-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338359164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse