Healthcare Provider Details

I. General information

NPI: 1992128615
Provider Name (Legal Business Name): JOSE SALCEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 WASHINGTON AVE
HOMESTEAD FL
33030-6036
US

IV. Provider business mailing address

7200 CORPORATE CENTER DR STE 600
MIAMI FL
33126-1200
US

V. Phone/Fax

Practice location:
  • Phone: 305-245-0200
  • Fax: 305-245-6186
Mailing address:
  • Phone: 305-500-2017
  • Fax: 305-500-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA43208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: