=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619281094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEDRO DAVID SALIB O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2010
-----------------------------------------------------
Last Update Date | 07/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAROLINA SHOPP CTR AVE. FRAGOSO, FIRST FLOOR, LOCAL 108
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985-5672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-708-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | LAS FLORES DE MONTEHIEDRA 300 CALLE ROMERILLO BUZON 680
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-708-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 135
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------