Basic Information
| Provider Information | |||||||||
| NPI: | 1174642516 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FERNANDO SALVATO P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WEST AVE APT 411 | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331395541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053246440 | ||||||||
| FaxNumber: | 3053248050 | ||||||||
| Practice Location | |||||||||
| Address1: | 11750 SW 40TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052233000 | ||||||||
| FaxNumber: | 3053248050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | SALVATO | ||||||||
| AuthorizedOfficialFirstName: | MIREILLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3053246440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 053553200 | 05 | FL | MEDICAID | 259297500 | 05 | FL | MEDICAID |