Healthcare Provider Details

I. General information

NPI: 1801059845
Provider Name (Legal Business Name): SALAS MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 SEQUOIA AVE
LINDSAY CA
93247-1422
US

IV. Provider business mailing address

973 SEQUOIA AVE.
LINDSAY CA
93247-1422
US

V. Phone/Fax

Practice location:
  • Phone: 559-784-6878
  • Fax: 559-784-1592
Mailing address:
  • Phone: 559-784-6878
  • Fax: 559-784-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA38943
License Number StateCA

VIII. Authorized Official

Name: JOSE R SALAS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 559-784-6878