Healthcare Provider Details

I. General information

NPI: 1114435062
Provider Name (Legal Business Name): ELVA SALCIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N GRAND AVE
WALNUT CA
91789-1341
US

IV. Provider business mailing address

1100 N GRAND AVE
WALNUT CA
91789-1341
US

V. Phone/Fax

Practice location:
  • Phone: 909-274-7500
  • Fax: 909-274-2312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: