Healthcare Provider Details

I. General information

NPI: 1407413065
Provider Name (Legal Business Name): ELYSSA MARIE SALCIDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEATLH CLINIC QUANTICO 3259 CATLIN AVENUE
QUANTICO VA
22134
US

IV. Provider business mailing address

13207 RAVEN ROOST DR
CYPRESS TX
77429-3883
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1725
  • Fax:
Mailing address:
  • Phone: 832-891-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: