Healthcare Provider Details

I. General information

NPI: 1760487748
Provider Name (Legal Business Name): RAUL ANTONIO SALCEDO D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/31/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB HERMANAS DAVILA CALLE J EDIFICIO HERMANAS DAVILA OFIC 205
BAYAMON PR
00959-0000
US

IV. Provider business mailing address

PO BOX 764
DORADO PR
00646-0764
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-0058
  • Fax:
Mailing address:
  • Phone: 787-667-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number40
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: