=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316999535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIME CUETO SALVATIERRA P.A.-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 W OAK AVE
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93291-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-732-4362
-----------------------------------------------------
Fax | 559-732-4911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 W OAK AVE
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93291-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-530-3029
-----------------------------------------------------
Fax | 559-732-4911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA16514
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA16514
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------