Provider Demographics
NPI:1326081464
Name:SALLENBACH, TODD STEVENS (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STEVENS
Last Name:SALLENBACH
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 1:7457 EL PRADO CT
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2314
Mailing Address - Country:US
Mailing Address - Phone:760-365-5150
Mailing Address - Fax:
Practice Address - Street 1:HI-DESSERT MEDICAL CENTER
Practice Address - Street 2:6601 WHITE FEATHER ROAD
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-6601
Practice Address - Country:US
Practice Address - Phone:760-366-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79712207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A797120Medicaid
CAA79712Medicare UPIN
CA00A797121Medicare ID - Type Unspecified