Healthcare Provider Details

I. General information

NPI: 1134897168
Provider Name (Legal Business Name): SALAS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W FLAGLER ST
CORAL GABLES FL
33134-1608
US

IV. Provider business mailing address

3900 W FLAGLER ST
CORAL GABLES FL
33134-1608
US

V. Phone/Fax

Practice location:
  • Phone: 305-717-8494
  • Fax:
Mailing address:
  • Phone: 305-717-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO LOPEZ
Title or Position: AMBR
Credential: PTA
Phone: 786-523-3208