Provider Demographics
NPI:1215330170
Name:SALCEDO, LISET
Entity type:Individual
Prefix:
First Name:LISET
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-0151
Mailing Address - Country:US
Mailing Address - Phone:951-212-5871
Mailing Address - Fax:
Practice Address - Street 1:6296 RIVER CREST DR
Practice Address - Street 2:SUITE K
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0742
Practice Address - Country:US
Practice Address - Phone:951-867-3800
Practice Address - Fax:951-867-3840
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 171M00000X
CA863521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator