Healthcare Provider Details

I. General information

NPI: 1174249734
Provider Name (Legal Business Name): LAURA FAITH SALDIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NW 55TH ST
MIAMI FL
33127-1823
US

IV. Provider business mailing address

755 NW 55TH ST
MIAMI FL
33127-1823
US

V. Phone/Fax

Practice location:
  • Phone: 773-865-2090
  • Fax:
Mailing address:
  • Phone: 773-865-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number11019213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: