Provider Demographics
NPI:1851780472
Name:SALDIVAR, GILBERT
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:SALDIVAR
Suffix:
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 1:3922 N BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4002
Mailing Address - Country:US
Mailing Address - Phone:619-490-8611
Mailing Address - Fax:
Practice Address - Street 1:4118 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1601
Practice Address - Country:US
Practice Address - Phone:619-490-8611
Practice Address - Fax:626-502-1689
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer