Provider Demographics
NPI:1811070063
Name:SALCIDO, DENNIS (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SALCIDO
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 1:155 N JACKSON AVE
Mailing Address - Street 2:201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1925
Mailing Address - Country:US
Mailing Address - Phone:408-923-6440
Mailing Address - Fax:408-923-0572
Practice Address - Street 1:155 N JACKSON AVE
Practice Address - Street 2:201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1925
Practice Address - Country:US
Practice Address - Phone:408-923-6440
Practice Address - Fax:408-923-0572
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33066208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A330660Medicaid
00A330660Medicare ID - Type Unspecified
CA00A330660Medicaid