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General NPI Number Information
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NPI Number | 1245635853
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Entity Type | Organization
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Legal Business Name | MARIO SALGUERO INC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 11858 BERNARDO PLAZA CT SUITE 210
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City | SAN DIEGO
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State | CA
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Zip | 92128-2439
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Country | US
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Telephone | 858-461-1142
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Fax | 888-965-3536
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 619-464-1165
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Fax | 619-567-1011
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARIO LUIS SALGUERO GALLAND
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Credential | M.D.
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Telephone | 858-461-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A122101
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License Number State | CA
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