Provider Demographics
NPI:1467561142
Name:SALDI,LTD,BDA, COVENANT MEDICAL GROUP
Entity Type:Organization
Organization Name:SALDI,LTD,BDA, COVENANT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERASTO
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-459-5500
Mailing Address - Street 1:4550 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5525
Mailing Address - Country:US
Mailing Address - Phone:702-938-6972
Mailing Address - Fax:702-938-6962
Practice Address - Street 1:4550 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5525
Practice Address - Country:US
Practice Address - Phone:702-938-6972
Practice Address - Fax:702-938-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101030Medicare ID - Type UnspecifiedGROUP#