Provider Demographics
NPI:1679123376
Name:SALAS, PAUL ANTHONY (STFA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:SALAS
Suffix:
Gender:M
Credentials:STFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 IRON OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3280
Mailing Address - Country:US
Mailing Address - Phone:813-505-0489
Mailing Address - Fax:
Practice Address - Street 1:9071 IRON OAK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3280
Practice Address - Country:US
Practice Address - Phone:813-505-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL90901246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant