Provider Demographics
NPI:1598169880
Name:SALINAS, FAUSTO J (PA-C)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:J
Last Name:SALINAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2961
Mailing Address - Country:US
Mailing Address - Phone:954-915-7322
Mailing Address - Fax:
Practice Address - Street 1:7737 N UNIVERSITY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2961
Practice Address - Country:US
Practice Address - Phone:954-915-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant