Provider Demographics
NPI:1821494618
Name:SALDIVAR, BENJAMIN A (HIS)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:A
Last Name:SALDIVAR
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3914
Mailing Address - Country:US
Mailing Address - Phone:225-387-3208
Mailing Address - Fax:225-387-3266
Practice Address - Street 1:4273 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3914
Practice Address - Country:US
Practice Address - Phone:225-387-3208
Practice Address - Fax:225-387-3266
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1211237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist