Provider Demographics
NPI:1548540909
Name:SALLENT MEDICAL GROUP, PSC
Entity type:Organization
Organization Name:SALLENT MEDICAL GROUP, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-371-1202
Mailing Address - Street 1:TORRIMAR ESTATES A3, PARK PLACE ST.
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-371-1202
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #172 KM 7.5 BO. CERTENEJAS
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-371-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16990261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1447457700OtherNPI