Healthcare Provider Details

I. General information

NPI: 1538154398
Provider Name (Legal Business Name): JORGE ANTONIO SALLENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 US HIGHWAY 1
WEST PALM BEACH FL
33403-3598
US

IV. Provider business mailing address

500 US HIGHWAY 1
WEST PALM BEACH 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 Number0038960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: