Healthcare Provider Details

I. General information

NPI: 1760662175
Provider Name (Legal Business Name): SALLENT'S PEDIATRIC RESPIRATORY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N FEDERAL HWY
LAKE PARK FL
33403-3598
US

IV. Provider business mailing address

500 N FEDERAL HWY
LAKE PARK FL
33403-3598
US

V. Phone/Fax

Practice location:
  • Phone: 561-863-0105
  • Fax: 561-863-6779
Mailing address:
  • Phone: 561-863-0105
  • Fax: 561-863-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME0038960
License Number StateFL

VIII. Authorized Official

Name: DR. JORGE ANTONIO SALLENT
Title or Position: DIRECTOR
Credential: M.D.
Phone: 561-863-0105