Healthcare Provider Details

I. General information

NPI: 1316141682
Provider Name (Legal Business Name): JAVIER CONCEPCION SALAS-RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MIRAMAR STREET 209 BO. GUANIQUILLA, PARCELAS NUEVA
AGUADA PR
00602
US

IV. Provider business mailing address

ROAD 2 126.4KM
AGUADILLA PR
00605
US

V. Phone/Fax

Practice location:
  • Phone: 939-969-4257
  • Fax:
Mailing address:
  • Phone: 787-882-2700
  • Fax: 787-882-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number14468
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: