Provider Demographics
NPI:1548509979
Name:SALCEDO-SAMPER, GINA PATRICIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:PATRICIA
Last Name:SALCEDO-SAMPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 WHITETHORN DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 SW 75TH AVE
Practice Address - Street 2:WGRH NEUROPSYCHOLOGY DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2800
Practice Address - Country:US
Practice Address - Phone:305-260-1931
Practice Address - Fax:786-235-1074
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8702103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist