Healthcare Provider Details

I. General information

NPI: 1548663529
Provider Name (Legal Business Name): ROSSALYNN MARIE SALCIDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CAMDEN ST STE 101
SAN ANTONIO TX
78215-2100
US

IV. Provider business mailing address

13371 LEEWARD LN
SAN ANTONIO TX
78263-2383
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax:
Mailing address:
  • Phone: 210-788-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09325
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: