Healthcare Provider Details

I. General information

NPI: 1790392892
Provider Name (Legal Business Name): SALUTEM MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 04/22/2024
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NW 107TH AVE STE 300
MIAMI FL
33172-3157
US

IV. Provider business mailing address

760 NW 107TH AVE STE 300
MIAMI FL
33172-3157
US

V. Phone/Fax

Practice location:
  • Phone: 305-387-7740
  • Fax: 305-387-7741
Mailing address:
  • Phone: 305-387-7740
  • Fax: 305-387-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CARLOS RODRIGUEZ
Title or Position: OWNER
Credential: MD
Phone: 786-452-6858