Healthcare Provider Details

I. General information

NPI: 1013421320
Provider Name (Legal Business Name): ELIZABETH ALEXANDRA SALCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18623 GALE AVE
CITY OF INDUSTRY CA
91748-1342
US

IV. Provider business mailing address

786 E RIO GRANDE ST
PASADENA CA
91104-5042
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-0300
  • Fax:
Mailing address:
  • Phone: 626-756-6904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number691958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: