Healthcare Provider Details

I. General information

NPI: 1205076247
Provider Name (Legal Business Name): JANICE CRESPO - SALGADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINICA DE LA ESCUELA DE MEDICINA REPARTO METROPOLITANO SHOPPING AVE AMERICO MIRANDA
RIO PIEDRAS PR
00921-2213
US

IV. Provider business mailing address

PO BOX 29134 NEFROLOGIA PEDIATRICA RCM
SAN JUAN PR
00929-0134
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-7908
  • Fax: 787-751-1508
Mailing address:
  • Phone: 787-758-7908
  • Fax: 787-751-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18250
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number18250
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: