Provider Demographics
NPI:1376884528
Name:SALCEDO, EDUARDO JAVIER (NP)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JAVIER
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 J ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5244
Mailing Address - Country:US
Mailing Address - Phone:619-571-0606
Mailing Address - Fax:
Practice Address - Street 1:1637 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5823
Practice Address - Country:US
Practice Address - Phone:619-205-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22507363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner