Provider Demographics
NPI:1043643067
Name:JUAN JESUS SALINA MD CORP
Entity Type:Organization
Organization Name:JUAN JESUS SALINA MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:SALINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-821-5525
Mailing Address - Street 1:4212 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7629
Mailing Address - Country:US
Mailing Address - Phone:305-821-5525
Mailing Address - Fax:786-342-6017
Practice Address - Street 1:4212 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7629
Practice Address - Country:US
Practice Address - Phone:305-821-5525
Practice Address - Fax:786-342-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty