=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689776072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIRENE MARGARITA SALAZAR P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2731 EXECUTIVE PARK DR STE 4
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-3619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-302-8382
-----------------------------------------------------
Fax | 954-626-3658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 71 STREET SUITE 620
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33141-3089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-554-8087
-----------------------------------------------------
Fax | 877-284-8933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9103693
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------