MEDICARE: MARIA DEL PILAR LUNA SALGADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BACB562506	OTHER	FL	BACB CREDENTIAL

General Provider Information

NPI Number	:	1023629573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DEL PILAR LUNA SALGADO

Provider Business Mailing Address
First Line	:	21701 NW 3RD ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1038
Country	:	US
Telephone Number	:	786-451-2196
Fax Number	:

Provider Business Practice Location Address
First Line	:	21701 NW 3RD ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1038
Country	:	US
Telephone Number	:	786-451-2196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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