=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437273729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J RAUL SALAS, MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 03/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 W PUTNAM AVE
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-784-6888
-----------------------------------------------------
Fax | 559-784-1592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 667 W BELLEVIEW AVE
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-2176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-310-8729
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSE RAUL SALAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-310-8729
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 301370
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | A38943
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------