=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043643067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN JESUS SALINA MD CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2013
-----------------------------------------------------
Last Update Date | 08/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4212 W 16TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-7629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-5525
-----------------------------------------------------
Fax | 786-342-6017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4212 W 16TH AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-7629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-5525
-----------------------------------------------------
Fax | 786-342-6017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JUAN JESUS SALINA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-821-5525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME80147
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------