Provider Demographics
NPI:1598515439
Name:SALCEDO, MICHELLE DOMINIQUE (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOMINIQUE
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 CAMINITO MUNDO UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2303
Mailing Address - Country:US
Mailing Address - Phone:760-981-9652
Mailing Address - Fax:
Practice Address - Street 1:885 CANARIOS CT STE 110
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7877
Practice Address - Country:US
Practice Address - Phone:619-656-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51055225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant