MEDICARE: DR. JUAN JESUS SALINA M.D

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	208D00000X	General Practice Physician	ME80147	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104836287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN JESUS SALINA M.D

Provider Business Mailing Address
First Line	:	4212 W 16 AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7629
Country	:	US
Telephone Number	:	305-821-5525
Fax Number	:	305-821-5590

Provider Business Practice Location Address
First Line	:	4212 W 16 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/14/2020

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