Provider Demographics
NPI:1427819051
Name:SALOM, ROSA V
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:V
Last Name:SALOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18901 SW 106TH AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7665
Mailing Address - Country:US
Mailing Address - Phone:786-732-0071
Mailing Address - Fax:
Practice Address - Street 1:18901 SW 106TH AVE STE 224
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7665
Practice Address - Country:US
Practice Address - Phone:786-732-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health