Provider Demographics
NPI:1659402428
Name:SALCEDO, LILIAN FARJEAT (PSYD)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:FARJEAT
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:
Other - Last Name:FARJEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:9620 CHESAPEAKE DR
Practice Address - Street 2:STE. 206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1369
Practice Address - Country:US
Practice Address - Phone:619-814-6590
Practice Address - Fax:619-814-6591
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27357103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN