Provider Demographics
NPI:1487104717
Name:SALOPEK, AMANDA (RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SALOPEK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 MESILLA ACRES RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-4214
Mailing Address - Country:US
Mailing Address - Phone:575-642-0081
Mailing Address - Fax:
Practice Address - Street 1:2875 MESILLA ACRES RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-4214
Practice Address - Country:US
Practice Address - Phone:575-642-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84382133V00000X
NMLD0928133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered