Healthcare Provider Details

I. General information

NPI: 1588372122
Provider Name (Legal Business Name): ISABELLA TIU SALCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N LA BREA AVE
WEST HOLLYWOOD CA
90038-1023
US

IV. Provider business mailing address

1233 N LA BREA AVE
WEST HOLLYWOOD CA
90038-1023
US

V. Phone/Fax

Practice location:
  • Phone: 310-876-5651
  • Fax: 310-876-5316
Mailing address:
  • Phone: 702-355-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH87216
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH87216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: