Provider Demographics
NPI:1760662175
Name:SALLENT'S PEDIATRIC RESPIRATORY CENTER
Entity type:Organization
Organization Name:SALLENT'S PEDIATRIC RESPIRATORY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SALLENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-863-0105
Mailing Address - Street 1:500 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3598
Mailing Address - Country:US
Mailing Address - Phone:561-863-0105
Mailing Address - Fax:561-863-6779
Practice Address - Street 1:500 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3598
Practice Address - Country:US
Practice Address - Phone:561-863-0105
Practice Address - Fax:561-863-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00389602080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279916200Medicaid