MEDICARE: JUAN JESUS SALINA MD CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME80147	FL

General Provider Information

NPI Number	:	1043643067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAN JESUS SALINA MD CORP

Provider Business Mailing Address
First Line	:	4212 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7629
Country	:	US
Telephone Number	:	305-821-5525
Fax Number	:	786-342-6017

Provider Business Practice Location Address
First Line	:	4212 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7629
Country	:	US
Telephone Number	:	305-821-5525
Fax Number	:	786-342-6017

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUAN JESUS SALINA
Credential	:	MD
Telephone Number	:	305-821-5525

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	08/13/2013

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