Provider Demographics
NPI:1194832972
Name:SALDIVAR, JUAN-SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN-SEBASTIAN
Middle Name:
Last Name:SALDIVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5059
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017
Mailing Address - Country:US
Mailing Address - Phone:626-775-3200
Mailing Address - Fax:626-775-3271
Practice Address - Street 1:1500 E DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-359-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84473207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A844730Medicaid
CAWA84673BMedicare ID - Type Unspecified
CA00A844730Medicaid