Provider Demographics
NPI:1043195654
Name:SALVADOR, DESIRAE M (CCHW)
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:M
Last Name:SALVADOR
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAGEBRUSH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-3942
Mailing Address - Country:US
Mailing Address - Phone:505-510-7491
Mailing Address - Fax:505-510-7491
Practice Address - Street 1:1 SAGEBRUSH ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3942
Practice Address - Country:US
Practice Address - Phone:505-510-7491
Practice Address - Fax:505-510-7491
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-1762172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker