Provider Demographics
NPI:1538241401
Name:PAREDES-SALCEDA, AIDE IRENE (PAC)
Entity type:Individual
Prefix:
First Name:AIDE
Middle Name:IRENE
Last Name:PAREDES-SALCEDA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:SALCEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:220 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2517
Practice Address - Country:US
Practice Address - Phone:707-641-1900
Practice Address - Fax:707-554-2294
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21677ZOtherFQHC MEDICARE PART B
CAHAP70816FOtherFPACT
CAFHC70816FMedicaid
CA55-1976OtherFQHC MEDICARE PART A
CAHAP70816FOtherFPACT