Provider Demographics
NPI:1689776072
Name:SALAZAR, MARIRENE MARGARITA (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARIRENE
Middle Name:MARGARITA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARIRENE
Other - Middle Name:MARGARITA
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:300 71 STREET
Mailing Address - Street 2:SUITE 620
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3089
Mailing Address - Country:US
Mailing Address - Phone:954-554-8087
Mailing Address - Fax:877-284-8933
Practice Address - Street 1:300 71ST STREET
Practice Address - Street 2:SUITE 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3089
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:305-614-3352
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103693363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00769974OtherRAILROAD MEDICARE
FLCJ795CMedicare PIN