1336301332 NPI number — RAY SALCEDO, M.D., INC.

Table of content: (NPI 1336301332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336301332 NPI number — RAY SALCEDO, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAY SALCEDO, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336301332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91357-7001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-888-7815
Provider Business Mailing Address Fax Number:
818-715-1722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-676-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALCEDO
Authorized Official First Name:
RAYMUNDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT SOLE OWNER
Authorized Official Telephone Number:
818-888-7815

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  A92734 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X , with the licence number: A92734 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00A927340 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".