Healthcare Provider Details

I. General information

NPI: 1740945088
Provider Name (Legal Business Name): DAVID JOSEPH RODAS SALGUERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 S MAIN ST FL 2
CORONA CA
92882-5942
US

IV. Provider business mailing address

2813 S MAIN ST FL 2
CORONA CA
92882-5942
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-2962
  • Fax: 951-737-2783
Mailing address:
  • Phone: 951-737-2962
  • Fax: 951-737-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberMPSS-MGDBEO
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MGDBEO
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: