MEDICARE: DR. LUIS R. SALGADO-DIAZ M.D.

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	146D00000X	Personal Emergency Response Attendant	8624	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8-0689	OTHER	PR	BLUE SHIELD

General Provider Information

NPI Number	:	1285632315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS R. SALGADO-DIAZ M.D.

Provider Business Mailing Address
First Line	:	CALLE 1
Second Line	:	# 104 PASEO LAS VISTAS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-1700
Country	:	US
Telephone Number	:	939-639-6910
Fax Number	:	787-760-8544

Provider Business Practice Location Address
First Line	:	CALLE 1
Second Line	:	# 104 PASEO LAS VISTAS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-1700
Country	:	US
Telephone Number	:	939-639-6910
Fax Number	:	787-760-8544

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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