Provider Demographics
NPI:1912712365
Name:MOSCOTE SALAZAR, LUIS RAFAEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RAFAEL
Last Name:MOSCOTE SALAZAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 S TONNE DR APT 214
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4127
Mailing Address - Country:US
Mailing Address - Phone:608-260-5633
Mailing Address - Fax:
Practice Address - Street 1:2145 S TONNE DR APT 214
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4127
Practice Address - Country:US
Practice Address - Phone:608-260-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
WI25-146156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No156F00000XEye and Vision Services ProvidersTechnician/Technologist