Provider Demographics
NPI:1619154804
Name:ELIZABETH SALADA MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELIZABETH SALADA MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:858-312-5492
Mailing Address - Street 1:15611 POMERADO RD STE 520
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2437
Mailing Address - Country:US
Mailing Address - Phone:858-312-5492
Mailing Address - Fax:858-312-6421
Practice Address - Street 1:15611 POMERADO RD STE 520
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-312-5492
Practice Address - Fax:858-312-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82274Medicare PIN
G30601Medicare UPIN