Individual
RAQUEL SALAZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2160 S 1ST AVE, EMS (110) BUILDING, SUITE 6237, MAYWOOD, IL 60153-3328
(708) 327-2503
Mailing address
2160 S 1ST AVE, EMS (110) BUILDING, SUITE 6237, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2212-023
WI
363AS0400X
Surgical Physician Assistant
Primary
085003709
IL
363AS0400X
Surgical Physician Assistant
2212-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38180400
—
WI
Enumeration date
10/19/2007
Last updated
07/02/2015
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