Healthcare Provider Details

I. General information

NPI: 1578522413
Provider Name (Legal Business Name): JOSEPH SALEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date: SALEM JOSEPH 131 CAMINO REAL GURABO PR 00778 LAGUNA GARDEN SHOP CTR ISLA VERDE PR 00979
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAGUNA GARDEN SHOP CTR STE 200A
ISLA VERDE PR
00979
US

IV. Provider business mailing address

131 CAMINO REAL URB GRAN VISTA I
GURABO PR
00778-5004
US

V. Phone/Fax

Practice location:
  • Phone: 787-253-3328
  • Fax: 787-253-3328
Mailing address:
  • Phone: 787-253-3328
  • Fax: 787-253-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics
License Number10552
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: