Provider Demographics
NPI:1508220484
Name:BARQUERO SALAZAR, JEFFRY ANTONIO
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:ANTONIO
Last Name:BARQUERO SALAZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EASTWIND LN
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2911
Mailing Address - Country:US
Mailing Address - Phone:407-233-7361
Mailing Address - Fax:
Practice Address - Street 1:107 EASTWIND LN
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2911
Practice Address - Country:US
Practice Address - Phone:407-233-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
FLSI2776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency