Healthcare Provider Details

I. General information

NPI: 1922076231
Provider Name (Legal Business Name): VIRGILIO GILBERT SALDAJENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR UFJP PEDIATRIC CRITICAL CARE MEDICINE
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-8758
  • Fax: 904-306-9884
Mailing address:
  • Phone: 904-244-3660
  • Fax: 904-244-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME63878
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME63878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: