Provider Demographics
NPI:1821686676
Name:SALGADO, IRIAN CONSUELO (CBHCM)
Entity Type:Individual
Prefix:
First Name:IRIAN
Middle Name:CONSUELO
Last Name:SALGADO
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6460 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4139
Mailing Address - Country:US
Mailing Address - Phone:786-234-4371
Mailing Address - Fax:786-741-8506
Practice Address - Street 1:6460 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4139
Practice Address - Country:US
Practice Address - Phone:786-234-4371
Practice Address - Fax:786-741-8506
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP100628Medicaid