Provider Demographics
NPI:1427062157
Name:SALAS, JOSE RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAUL
Last Name:SALAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 W BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2176
Mailing Address - Country:US
Mailing Address - Phone:559-310-8729
Mailing Address - Fax:
Practice Address - Street 1:833 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1424
Practice Address - Country:US
Practice Address - Phone:559-562-1361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389430Medicaid
CANMW1108Medicaid
CAZZZ02023ZMedicare ID - Type UnspecifiedMEDICARE GRP ID#
CAA27866Medicare UPIN
CAZZZ02024ZMedicare ID - Type UnspecifiedPPIN