Provider Demographics
NPI:1013112689
Name:SALAS MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:SALAS MEDICAL CLINIC, INC.
Other - Org Name:SALAS MEDICAL CLINIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RUAL
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-784-6888
Mailing Address - Street 1:575 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3270
Mailing Address - Country:US
Mailing Address - Phone:559-784-6888
Mailing Address - Fax:559-784-1592
Practice Address - Street 1:575 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3270
Practice Address - Country:US
Practice Address - Phone:559-784-6888
Practice Address - Fax:559-784-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38943261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389430Medicaid