Healthcare Provider Details

I. General information

NPI: 1295701977
Provider Name (Legal Business Name): VICTOR SALIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33758 YUCAIPA BLVD
YUCAIPA CA
92399
US

IV. Provider business mailing address

1615 ORANGE TREE LN
REDLANDS CA
92374-4501
US

V. Phone/Fax

Practice location:
  • Phone: 909-795-9747
  • Fax: 909-797-3922
Mailing address:
  • Phone: 909-786-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC132336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: