Provider Demographics
NPI:1770743585
Name:SALAS MEDICAL GROUP
Entity type:Organization
Organization Name:SALAS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SALAS RUSHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-525-1995
Mailing Address - Street 1:559 CALLE CABO H ALVERIO
Mailing Address - Street 2:EXT. ROOSEVELT
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3725
Mailing Address - Country:US
Mailing Address - Phone:787-525-1995
Mailing Address - Fax:
Practice Address - Street 1:559 CALLE CABO H ALVERIO
Practice Address - Street 2:EXT. ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3725
Practice Address - Country:US
Practice Address - Phone:787-525-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16462208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty