Provider Demographics
NPI:1235495144
Name:LOPEZ DE SALCEDO, MARTHA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LOPEZ DE SALCEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W HIGHLAND AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1253
Mailing Address - Country:US
Mailing Address - Phone:909-522-4656
Mailing Address - Fax:
Practice Address - Street 1:1505 W HIGHLAND AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1253
Practice Address - Country:US
Practice Address - Phone:909-522-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor