Provider Demographics
NPI:1871297531
Name:THE PLASTICS DOC, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:THE PLASTICS DOC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-268-6168
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:951-268-9616
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:951-268-9616
Practice Address - Fax:951-268-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty