Provider Demographics
NPI:1447518733
Name:SALCEDO, SAMUEL ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ENRIQUE
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4226 GREEN RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3829
Mailing Address - Country:US
Mailing Address - Phone:951-268-6168
Mailing Address - Fax:951-268-7756
Practice Address - Street 1:4226 GREEN RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-3829
Practice Address - Country:US
Practice Address - Phone:951-268-6168
Practice Address - Fax:951-268-7756
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126962208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery