1063519452 NPI number — DR. JACQUELINE SALAZAR M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063519452 NPI number — DR. JACQUELINE SALAZAR M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SALAZAR

Provider First Name:

JACQUELINE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1063519452

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/04/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

16241 BISCAYNE BLVD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NORTH MIAMI BEACH

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33160

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

305-947-5494

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

8900 N KENDALL DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MIAMI

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33176-2118

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

786-596-1960

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  ME0046576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: ME46576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X , with the licence number: ME46576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 650122664 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 001785 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 110994 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 212947 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 063887101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 1202314 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 02871 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 014227 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 171113 . This is a "JMH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 012 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".