MEDICARE: MISS MARIA VANESSA COMIA SALVADOR M.E.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	174400000X	Specialist

General Provider Information

NPI Number	:	1891931267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA VANESSA COMIA SALVADOR M.E.D.

Provider Business Mailing Address
First Line	:	9738 SUMMER GROVE WAY W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8872
Country	:	US
Telephone Number	:	904-861-5896
Fax Number	:

Provider Business Practice Location Address
First Line	:	9857 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 6
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8853
Country	:	US
Telephone Number	:	904-880-9001
Fax Number	:

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	01/06/2009

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