Provider Demographics
NPI:1760953343
Name:SALCIDO, CELIA SUSANNA
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:SUSANNA
Last Name:SALCIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 N YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4856
Mailing Address - Country:US
Mailing Address - Phone:909-296-0193
Mailing Address - Fax:
Practice Address - Street 1:275 W HOSPITALITY LN STE 324
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3249
Practice Address - Country:US
Practice Address - Phone:800-951-9813
Practice Address - Fax:909-571-6806
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235650516Medicaid