Healthcare Provider Details

I. General information

NPI: 1104802180
Provider Name (Legal Business Name): JUAN LUIS SALGADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CALLE DEL PARQUE
SAN JUAN PR
00909
US

IV. Provider business mailing address

PO BOX 19450 FDZ JUNCOS STATION
SAN JUAN PR
00910
US

V. Phone/Fax

Practice location:
  • Phone: 787-982-0088
  • Fax:
Mailing address:
  • Phone: 787-982-0088
  • Fax: 787-982-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number8973
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: