MEDICARE: MS. JUANITA SALCEDO CM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639351356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUANITA SALCEDO CM

Provider Business Mailing Address
First Line	:	121 DOWNEY AVE
Second Line	:	SUITE 102
City	:	MODESTO
State	:	CA
Zip	:	95354-1208
Country	:	US
Telephone Number	:	209-558-8150
Fax Number	:	209-558-8648

Provider Business Practice Location Address
First Line	:	121 DOWNEY AVE
Second Line	:	SUITE 102
City	:	MODESTO
State	:	CA
Zip	:	95354-1208
Country	:	US
Telephone Number	:	209-558-8150
Fax Number	:	209-558-8648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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