MEDICARE: IRIAN CONSUELO SALGADO CBHCM

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821686676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIAN CONSUELO SALGADO CBHCM

Provider Business Mailing Address
First Line	:	6460 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4139
Country	:	US
Telephone Number	:	786-234-4371
Fax Number	:	786-741-8506

Provider Business Practice Location Address
First Line	:	6460 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4139
Country	:	US
Telephone Number	:	786-234-4371
Fax Number	:	786-741-8506

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

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	09/26/2021

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