Healthcare Provider Details

I. General information

NPI: 1013856566
Provider Name (Legal Business Name): JORGE EDUARDO SALCEDO SIFUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORGE SALCEDO

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STEIN PLAZA SUITE 420
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1215 BARRY AVE APT 7
LOS ANGELES CA
90025-5193
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5111
  • Fax:
Mailing address:
  • Phone: 317-658-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: