Provider Demographics
NPI:1265595086
Name:SALCEDO, RAMONA IGNACIO (SUBSTANCE COUNSELOR)
Entity type:Individual
Prefix:MISS
First Name:RAMONA
Middle Name:IGNACIO
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:SUBSTANCE COUNSELOR
Other - Prefix:
Other - First Name:RAMONA
Other - Middle Name:IGNACIO
Other - Last Name:SALCEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUBSTANCE COUNSELOR
Mailing Address - Street 1:1688 MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-2893
Mailing Address - Country:US
Mailing Address - Phone:209-644-7014
Mailing Address - Fax:
Practice Address - Street 1:1111 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1305
Practice Address - Country:US
Practice Address - Phone:209-938-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM2800X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center