Organization
CLINICA DR ALFONSO SALAS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANNET DECARDENAS (BILLING MANAGER)
(480) 897-1175
Entity
Organization
Contact information
Practice address
7734 N 59TH AVE, GLENDALE, AZ 85301-7816
(623) 931-2444
(623) 931-1099
Mailing address
PO BOX 355, GLENDALE, AZ 85311-0355
(623) 931-2444
(623) 931-1099
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
29615
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000083
—
AZ
05
—
173414
—
AZ
05
—
560337
—
AZ
05
—
587766
—
AZ
05
—
616245
—
AZ
Enumeration date
06/09/2008
Last updated
09/01/2011
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