Provider Information for 1629428693
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SAMUEL SALGADO Jr.
Sex: Male
NPI: 1629428693
Last Updated: 2020-11-03
Certification Date: 2020-11-03
Certification Date: 2020-11-03
Details
Name | Value | ||||||||||||
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NPI | 1629428693 | ||||||||||||
Enumeration Date | 2016-06-20 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 2275 S MAIN ST SUITE 201 CORONA, CA 92882-5303 United States Phone: 951-279-3222 | Fax: | ||||||||||||
Primary Practice Address | 17130 SEQUOIA ST STE 204 HESPERIA, CA 92345-1827 United States Phone: 951-205-9370 | Fax: | ||||||||||||
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