Basic Information
| Provider Information | |||||||||
| NPI: | 1912644550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAS RIVAS | ||||||||
| FirstName: | KARIMAR | ||||||||
| MiddleName: | NATHALY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9275 SW 152ND ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | PALMETTO BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331571774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052555995 | ||||||||
| FaxNumber: | 3052553018 | ||||||||
| Practice Location | |||||||||
| Address1: | 9275 SW 152ND ST STE 212 | ||||||||
| Address2: | |||||||||
| City: | PALMETTO BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331571774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052555995 | ||||||||
| FaxNumber: | 3052553018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2022 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 21-137 | WI | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.