Provider Demographics
NPI:1982761029
Name:SALERNO MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SALERNO MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EGISTO
Authorized Official - Middle Name:-
Authorized Official - Last Name:SALERNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-422-2555
Mailing Address - Street 1:2850 6TH AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6308
Mailing Address - Country:US
Mailing Address - Phone:619-422-2555
Mailing Address - Fax:619-422-2223
Practice Address - Street 1:2850 6TH AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6308
Practice Address - Country:US
Practice Address - Phone:619-422-2555
Practice Address - Fax:619-422-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty