Basic Information
| Provider Information | |||||||||
| NPI: | 1992013270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HECTOR SALEMI-CASTRO MD, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 E 21ST ST STE K | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924044851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098826900 | ||||||||
| FaxNumber: | 9098826110 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 WESTERN AVE STE 302 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924111354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098826900 | ||||||||
| FaxNumber: | 9098826110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 09/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | SALEMI-CASTRO | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2563436895 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A73975 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A739750 | 05 | CA | MEDICAID |