Provider Demographics
NPI:1295701977
Name:SALIB, VICTOR (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:SALIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 ORANGE TREE LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4501
Mailing Address - Country:US
Mailing Address - Phone:909-786-0725
Mailing Address - Fax:
Practice Address - Street 1:33758 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:909-795-9747
Practice Address - Fax:909-797-3922
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC132336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA139015Medicaid
VA96713OtherSENTARA/OPTIMA
VA010151481Medicaid
VA177421OtherANTHEM
VA541595397OtherMID ATLANTIC SOLUTIONS
VA7440665OtherAETNA
VA541595397OtherCIGNA
VA541595397OtherCIGNA
007653B28Medicare PIN