Provider Demographics
NPI:1295960102
Name:SALCEDO, JIME (PSYD)
Entity type:Individual
Prefix:
First Name:JIME
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:SALCIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA SANTA BARBARA
Mailing Address - Street 2:COUNSELING AND PSYCHOLOGICAL SERVICES BLDG 559
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-7030
Mailing Address - Country:US
Mailing Address - Phone:626-676-1264
Mailing Address - Fax:
Practice Address - Street 1:2100 GENG RD STE 210
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3307
Practice Address - Country:US
Practice Address - Phone:833-646-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295960102OtherMEDICAL