Healthcare Provider Details

I. General information

NPI: 1497873806
Provider Name (Legal Business Name): JOSEPHINE D SALUDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E. RUSSELL ROAD, SUITE319
LAS VEGAS NV
89120
US

IV. Provider business mailing address

1600 9TH STREET ROOM 250
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 702-214-4319
  • Fax: 702-214-4328
Mailing address:
  • Phone: 916-651-3154
  • Fax: 916-653-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number7990
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA55030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: