Basic Information
| Provider Information | |||||||||
| NPI: | 1316500788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAS ZUBILLAGA | ||||||||
| FirstName: | RODRIGO | ||||||||
| MiddleName: | JESUS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11260 NW 79TH LN | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331781437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322696670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1475 W 49TH PL | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330123113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2019 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | ME151993 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.