Provider Demographics
NPI:1780482596
Name:SALIDO, JULIAN BENEDICT (IDHS)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:BENEDICT
Last Name:SALIDO
Suffix:
Gender:
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 GROUPER RD
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-4402
Mailing Address - Country:US
Mailing Address - Phone:321-868-4228
Mailing Address - Fax:
Practice Address - Street 1:9235 GROUPER RD
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-4402
Practice Address - Country:US
Practice Address - Phone:321-868-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians