Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | Y4560897 | CA |
NPI | 1487116943 |
---|---|
Provider Name | Israel Ivan Salcido |
First Address | Chula Vista, CA 91911-4933 |
Second Address | Chula Vista, CA 91911-4933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |