Provider Demographics
NPI:1407093776
Name:SALOM, JAKOB R (CNMT, RT (N))
Entity Type:Individual
Prefix:MR
First Name:JAKOB
Middle Name:R
Last Name:SALOM
Suffix:
Gender:M
Credentials:CNMT, RT (N)
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1303 AVE MAGDALENA APT 803
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1917
Mailing Address - Country:US
Mailing Address - Phone:787-217-5141
Mailing Address - Fax:
Practice Address - Street 1:1409 AVE ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1435
Practice Address - Country:US
Practice Address - Phone:787-721-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT728952471N0900X
PR08922471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology