Healthcare Provider Details

I. General information

NPI: 1316500788
Provider Name (Legal Business Name): RODRIGO JESUS SALAS ZUBILLAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 NW 82ND AVE STE 404
DORAL FL
33166-6694
US

IV. Provider business mailing address

PO BOX 198175
ATLANTA GA
30384-8175
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1317
  • Fax: 305-279-6813
Mailing address:
  • Phone: 305-595-1317
  • Fax: 305-279-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME151993
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME151993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: