=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437699956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER GARCIA SALAS ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2017
-----------------------------------------------------
Last Update Date | 03/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 S ROYAL POINCIANA BLVD
-----------------------------------------------------
City | MIAMI SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-442-9223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 NW 22ND AVE APT 603
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-308-0054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 9340857
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------