Provider Demographics
NPI:1285219980
Name:SALCEDO, RUBEN R
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:R
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2826
Mailing Address - Country:US
Mailing Address - Phone:805-901-9299
Mailing Address - Fax:
Practice Address - Street 1:421 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2826
Practice Address - Country:US
Practice Address - Phone:805-901-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT00020185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist