Basic Information
| Provider Information | |||||||||
| NPI: | 1336301332 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAY SALCEDO, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7001 | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913577001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188887815 | ||||||||
| FaxNumber: | 8187151722 | ||||||||
| Practice Location | |||||||||
| Address1: | 7300 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913071902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186764000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | SALCEDO | ||||||||
| AuthorizedOfficialFirstName: | RAYMUNDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8188887815 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | A92734 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | A92734 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A927340 | 01 | CA | BLUE SHIELD | OTHER |