Provider Demographics
NPI:1841270519
Name:SALLABERRY, JORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:SALLABERRY
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:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3299
Mailing Address - Country:US
Mailing Address - Phone:775-222-0044
Mailing Address - Fax:888-700-0187
Practice Address - Street 1:1930 E ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3553
Practice Address - Country:US
Practice Address - Phone:719-561-8574
Practice Address - Fax:719-564-9180
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14732208M00000X
NV12639208M00000X
UT12639208M00000X
CO41468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56972377Medicaid
CO312097YMEWMedicare PIN
CO93266Medicare UPIN