MEDICARE: MAGDALENA CHAIDEZ SALCEDO MD

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	208000000X	Pediatrics Physician	G47591	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G475910	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1427059112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDALENA CHAIDEZ SALCEDO MD

Provider Business Mailing Address
First Line	:	1665 SCENIC AVE. SUITE 100
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626
Country	:	US
Telephone Number	:	714-835-8501
Fax Number	:	714-835-3912

Provider Business Practice Location Address
First Line	:	1002 N FAIRVIEW
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703
Country	:	US
Telephone Number	:	714-835-8501
Fax Number	:	714-835-3912

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/05/2012

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