Provider Demographics
NPI:1861905390
Name:SALINAS, CODY J (CSFA, LSA)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:J
Last Name:SALINAS
Suffix:
Gender:M
Credentials:CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 W BRAKER LN # 81603
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3606
Mailing Address - Country:US
Mailing Address - Phone:512-973-9222
Mailing Address - Fax:
Practice Address - Street 1:1822 W BRAKER LN # 81603
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3606
Practice Address - Country:US
Practice Address - Phone:512-973-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174982246ZC0007X
TXSA00785246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00785OtherTEXAS MEDICAL BOARD