Provider Demographics
NPI:1730647397
Name:SALDIVAR, TEODULFO JR
Entity Type:Individual
Prefix:MR
First Name:TEODULFO
Middle Name:
Last Name:SALDIVAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E F ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3033
Mailing Address - Country:US
Mailing Address - Phone:909-825-4186
Mailing Address - Fax:
Practice Address - Street 1:510 E F ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3033
Practice Address - Country:US
Practice Address - Phone:909-825-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician