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General NPI Number Information
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NPI Number | 1841270519
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Entity Type | Individual
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Provider Name | JORGE L SALLABERRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 1930 E ORMAN AVE
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City | PUEBLO
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State | CO
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Zip | 81004-3553
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Country | US
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Telephone | 719-561-8574
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Fax | 719-564-9180
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Provider Business Mailing Address
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Address Line | PO BOX 3299
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City | CARSON CITY
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State | NV
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Zip | 89702-3299
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Country | US
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Telephone | 775-222-0044
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Fax | 888-700-0187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | M-14732
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 12639
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 12639
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 41468
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License Number State | CO
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