MEDICARE: MR. NICHOLAS ANDREW SALCEDO M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	14973	CA
2	106H00000X	Marriage & Family Therapist	142420	CA

General Provider Information

NPI Number	:	1114709839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS ANDREW SALCEDO M.S.

Provider Business Mailing Address
First Line	:	5252 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6906
Country	:	US
Telephone Number	:	858-333-6856
Fax Number	:	858-999-2014

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6906
Country	:	US
Telephone Number	:	858-333-6856
Fax Number	:	858-999-2014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	05/19/2026

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