Provider Demographics
NPI:1639981012
Name:SALCEDO, JUAN DIEGO (MS, RD)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DIEGO
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 SEASCAPE WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0625
Mailing Address - Country:US
Mailing Address - Phone:386-627-3472
Mailing Address - Fax:
Practice Address - Street 1:4850 SEASCAPE WAY APT 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0625
Practice Address - Country:US
Practice Address - Phone:386-627-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11659133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered