Healthcare Provider Details

I. General information

NPI: 1114903184
Provider Name (Legal Business Name): JOSE MIGUEL SAMALOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA KAROMA
MANATI PR
00674-5956
US

IV. Provider business mailing address

PO BOX 1131
MANATI PR
00674-1131
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-7380
  • Fax: 787-854-7380
Mailing address:
  • Phone: 787-854-7380
  • Fax: 787-854-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7289
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2991
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerINTERNATIONAL MEDICAL CAR
# 2
Identifier99361SA
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE-S

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: