Provider Demographics
NPI:1740270230
Name:SALAGUBANG, JASON-LAMONT RIVERO (MD)
Entity type:Individual
Prefix:
First Name:JASON-LAMONT
Middle Name:RIVERO
Last Name:SALAGUBANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N PARK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4147
Mailing Address - Country:US
Mailing Address - Phone:407-814-2680
Mailing Address - Fax:407-814-2068
Practice Address - Street 1:201 N PARK AVE STE 201
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4147
Practice Address - Country:US
Practice Address - Phone:407-814-2680
Practice Address - Fax:407-814-2068
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270338600Medicaid
I15445Medicare UPIN
FL50015ZMedicare PIN