Provider Demographics
NPI:1790191799
Name:RINCON, SALVADOR (BSN,RN,CARN,PMH-BC)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:RINCON
Suffix:
Gender:M
Credentials:BSN,RN,CARN,PMH-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 N SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5201
Mailing Address - Country:US
Mailing Address - Phone:760-770-2286
Mailing Address - Fax:760-770-2240
Practice Address - Street 1:191 N SUNRISE WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5201
Practice Address - Country:US
Practice Address - Phone:760-770-2286
Practice Address - Fax:760-770-2240
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95223221163WA0400X, 163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health