Provider Demographics
NPI:1710061197
Name:GUERRERO & SALIB MD PA
Entity Type:Organization
Organization Name:GUERRERO & SALIB MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-267-6796
Mailing Address - Street 1:500 N WASHINGTON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2759
Mailing Address - Country:US
Mailing Address - Phone:321-267-6796
Mailing Address - Fax:321-269-0947
Practice Address - Street 1:500 N WASHINGTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2759
Practice Address - Country:US
Practice Address - Phone:321-267-6796
Practice Address - Fax:321-269-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38521Medicare ID - Type Unspecified