Provider Demographics
NPI:1568613107
Name:J. RAUL SALAS, M.D., INC
Entity Type:Organization
Organization Name:J. RAUL SALAS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:559-310-8729
Mailing Address - Street 1:667 W BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2176
Mailing Address - Country:US
Mailing Address - Phone:559-310-8729
Mailing Address - Fax:
Practice Address - Street 1:575 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3270
Practice Address - Country:US
Practice Address - Phone:559-784-6878
Practice Address - Fax:559-784-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAB58497H291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38943Medicaid
CAA38943Medicaid