Provider Demographics
NPI:1942900642
Name:SALCEDO, JHONN E
Entity Type:Individual
Prefix:
First Name:JHONN
Middle Name:E
Last Name:SALCEDO
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 1:19771 MORSANI RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-3320
Mailing Address - Country:US
Mailing Address - Phone:813-278-0367
Mailing Address - Fax:
Practice Address - Street 1:7820 BURNHAM DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4372
Practice Address - Country:US
Practice Address - Phone:813-278-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL928911253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care