Healthcare Provider Details

I. General information

NPI: 1952698862
Provider Name (Legal Business Name): VICTOR M SALCEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8129 LAKE BALLINGER WAY UNIT 105
EDMONDS WA
98026-9182
US

IV. Provider business mailing address

8129 LAKE BALLINGER WAY UNIT 105
EDMONDS WA
98026-9182
US

V. Phone/Fax

Practice location:
  • Phone: 206-865-0193
  • Fax: 206-238-2749
Mailing address:
  • Phone: 206-865-0193
  • Fax: 206-238-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60850555
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number60850555
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: