Provider Demographics
NPI:1114503638
Name:SALCEDO, NESTOR JUMALON JR
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:JUMALON
Last Name:SALCEDO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1204 HEAHEA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4712
Mailing Address - Country:US
Mailing Address - Phone:808-304-7614
Mailing Address - Fax:
Practice Address - Street 1:94-1204 HEAHEA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4712
Practice Address - Country:US
Practice Address - Phone:808-304-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician