Provider Demographics
NPI:1093060238
Name:RENE SALHAB MD INC
Entity Type:Organization
Organization Name:RENE SALHAB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:909-466-7337
Mailing Address - Street 1:8112 MILLIKEN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7473
Mailing Address - Country:US
Mailing Address - Phone:909-466-7337
Mailing Address - Fax:909-466-7338
Practice Address - Street 1:8112 MILLIKEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-466-7337
Practice Address - Fax:909-466-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA110333Medicaid