1013237866 NPI number — MARTHA C SALCIDO PA

Table of content: MARTHA C SALCIDO PA (NPI 1013237866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013237866 NPI number — MARTHA C SALCIDO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALCIDO
Provider First Name:
MARTHA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
MARTHA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013237866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 TEJAS PL
Provider Second Line Business Mailing Address:
PO BOX 430
Provider Business Mailing Address City Name:
NIPOMO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93444-9123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-929-3211
Provider Business Mailing Address Fax Number:
805-929-6440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMPOC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93436-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-737-1774
Provider Business Practice Location Address Fax Number:
805-737-1772
Provider Enumeration Date:
06/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA 20298 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CMM71074F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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