Provider Demographics
NPI:1326123399
Name:SALUD
Entity Type:Organization
Organization Name:SALUD
Other - Org Name:ST JOAN OF ARC MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:960-922-1020
Mailing Address - Street 1:176 S PALM DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225
Mailing Address - Country:US
Mailing Address - Phone:760-922-1020
Mailing Address - Fax:760-922-1050
Practice Address - Street 1:176 S PALM DRIVE
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225
Practice Address - Country:US
Practice Address - Phone:760-922-1020
Practice Address - Fax:760-922-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G115032Medicaid
C04113Medicare UPIN
CA00G115032Medicaid