Provider Demographics
NPI:1154376218
Name:SALCEDO, PEDRO L (PA)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:L
Last Name:SALCEDO
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Gender:
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:2885 SW LAKEMONT PL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-6096
Mailing Address - Country:US
Mailing Address - Phone:305-794-2939
Mailing Address - Fax:772-223-6354
Practice Address - Street 1:4243 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3600
Practice Address - Country:US
Practice Address - Phone:800-735-1178
Practice Address - Fax:772-223-6354
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102068363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111953100Medicaid
FLY09F9OtherBCBS