Provider Demographics
NPI:1427059112
Name:SALCEDO, MAGDALENA CHAIDEZ (MD)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:CHAIDEZ
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-835-8501
Mailing Address - Fax:714-835-3912
Practice Address - Street 1:1002 N FAIRVIEW
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703
Practice Address - Country:US
Practice Address - Phone:714-835-8501
Practice Address - Fax:714-835-3912
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47591208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G475910OtherMEDI CAL
CAF50534Medicare UPIN