Provider Demographics
NPI:1083700884
Name:VALLARTA, SALVALDOR O (OD)
Entity Type:Individual
Prefix:DR
First Name:SALVALDOR
Middle Name:O
Last Name:VALLARTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PAJARO ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3421
Mailing Address - Country:US
Mailing Address - Phone:831-757-4500
Mailing Address - Fax:831-757-4509
Practice Address - Street 1:311 PAJARO ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3421
Practice Address - Country:US
Practice Address - Phone:831-757-4500
Practice Address - Fax:831-757-4509
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10972T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD00109720Medicaid
CAU68215Medicare UPIN
CASD00109720Medicaid