Provider Demographics
NPI:1033966239
Name:PATINO SALAZAR, CARLOS ALAIN (SA-C)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALAIN
Last Name:PATINO SALAZAR
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 RUSTIC LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1605
Mailing Address - Country:US
Mailing Address - Phone:469-988-7691
Mailing Address - Fax:
Practice Address - Street 1:4108 RUSTIC LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1605
Practice Address - Country:US
Practice Address - Phone:469-988-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-266246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant