Provider Demographics
NPI:1457637787
Name:SALUD PRIMARY CARE LLC
Entity Type:Organization
Organization Name:SALUD PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:860-233-0112
Mailing Address - Street 1:60 GILLETT ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2637
Mailing Address - Country:US
Mailing Address - Phone:860-233-0112
Mailing Address - Fax:860-233-0120
Practice Address - Street 1:60 GILLETT ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2637
Practice Address - Country:US
Practice Address - Phone:860-233-0112
Practice Address - Fax:860-233-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035331Medicaid
CTD100059283Medicare PIN