Healthcare Provider Details

I. General information

NPI: 1437273729
Provider Name (Legal Business Name): J RAUL SALAS, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 W PUTNAM AVE
PORTERVILLE CA
93257-3270
US

IV. Provider business mailing address

667 W BELLEVIEW AVE
PORTERVILLE CA
93257-2176
US

V. Phone/Fax

Practice location:
  • Phone: 559-784-6888
  • Fax: 559-784-1592
Mailing address:
  • Phone: 559-310-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA38943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number301370
License Number StateCA

VIII. Authorized Official

Name: DR. JOSE RAUL SALAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-310-8729