MEDICARE: TODD STEVENS SALLENBACH M.D.

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	207P00000X	Emergency Medicine Physician	A79712	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326081464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD STEVENS SALLENBACH M.D.

Provider Business Mailing Address
First Line	:	7457 EL PRADO CT
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-2314
Country	:	US
Telephone Number	:	760-365-5150
Fax Number	:

Provider Business Practice Location Address
First Line	:	HI-DESSERT MEDICAL CENTER
Second Line	:	6601 WHITE FEATHER ROAD
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252-6601
Country	:	US
Telephone Number	:	760-366-3711
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/07/2011

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