MEDICARE: DR SALAS WELLNESS CENTER

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548001662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SALAS WELLNESS CENTER

Provider Business Mailing Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5216
Country	:	US
Telephone Number	:	904-723-4827
Fax Number	:	904-747-1633

Provider Business Practice Location Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5216
Country	:	US
Telephone Number	:	904-723-4827
Fax Number	:	904-747-1633

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE A SALAS
Credential	:	MD
Telephone Number	:	904-723-1633

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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Directions to “DR SALAS WELLNESS CENTER ” Practice Location

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