Basic Information
| Provider Information | |||||||||
| NPI: | 1992128615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALCEDO | ||||||||
| FirstName: | JOSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7200 CORPORATE CENTER DR | ||||||||
| Address2: | STE 600 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331261200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055002017 | ||||||||
| FaxNumber: | 3055002080 | ||||||||
| Practice Location | |||||||||
| Address1: | 442 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330306036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052450200 | ||||||||
| FaxNumber: | 3052456186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2014 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA43208 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.