| NPI | 1669369799 |
|---|---|
| Former Name | DESTINEE RENEE SALAZAR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA19112) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA19112) |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-09-04 |