Provider Demographics
NPI:1104836287
Name:SALINA, JUAN JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JESUS
Last Name:SALINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 W 16 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:305-821-5590
Practice Address - Street 1:4212 W 16 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80147208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4148Medicare PIN
FLH16302Medicare UPIN