Healthcare Provider Details

I. General information

NPI: 1144823733
Provider Name (Legal Business Name): MR. SAUL SALIDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 04/27/2024
Certification Date: 04/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 NE 11TH ST
RENTON WA
98059-4407
US

IV. Provider business mailing address

4105 NE 11TH ST
RENTON WA
98059-4407
US

V. Phone/Fax

Practice location:
  • Phone: 206-293-7930
  • Fax: 206-260-1348
Mailing address:
  • Phone: 206-293-7930
  • Fax: 206-260-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number6317
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: