Provider Demographics
NPI:1598803306
Name:SALCEDO, GINA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA MARIE
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HAILI ST STE B
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2975
Mailing Address - Country:US
Mailing Address - Phone:808-934-3236
Mailing Address - Fax:
Practice Address - Street 1:1178 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7206
Practice Address - Country:US
Practice Address - Phone:808-934-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94810207Q00000X
HIMD 13746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine