Provider Demographics
NPI:1588372122
Name:SALCEDO, ISABELLA TIU
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:TIU
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 1:515 S ST ANDREWS PL APT 17
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4420
Mailing Address - Country:US
Mailing Address - Phone:702-355-8983
Mailing Address - Fax:
Practice Address - Street 1:11727 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1202
Practice Address - Country:US
Practice Address - Phone:310-444-0603
Practice Address - Fax:310-444-0498
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH87216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist