Provider Demographics
NPI:1992995724
Name:SALDIVAR, LUTEA (NMD)
Entity type:Individual
Prefix:
First Name:LUTEA
Middle Name:
Last Name:SALDIVAR
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S POWER RD
Mailing Address - Street 2:STE #101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5245
Mailing Address - Country:US
Mailing Address - Phone:480-214-0051
Mailing Address - Fax:480-214-0055
Practice Address - Street 1:1311 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5707
Practice Address - Country:US
Practice Address - Phone:602-322-1315
Practice Address - Fax:602-322-1316
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-851175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ05-851OtherAZ STATE LICENSE