Healthcare Provider Details

I. General information

NPI: 1831036565
Provider Name (Legal Business Name): PRETORIAN X LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18021 SKY PARK CIR
IRVINE CA
92614-6523
US

IV. Provider business mailing address

9330 PECAN ST
CYPRESS CA
90630-2931
US

V. Phone/Fax

Practice location:
  • Phone: 714-458-2165
  • Fax:
Mailing address:
  • Phone: 714-767-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER SALEM
Title or Position: DIRECTOR
Credential:
Phone: 714-458-2165