Provider Demographics
NPI:1730728742
Name:SALDUA, KENNETH SAAVEDRA (NP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:SAAVEDRA
Last Name:SALDUA
Suffix:
Gender:M
Credentials:NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24448 RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-0364
Mailing Address - Country:US
Mailing Address - Phone:909-964-3951
Mailing Address - Fax:
Practice Address - Street 1:4173 ENTERPRISE CIRCLE N
Practice Address - Street 2:SUITE B206
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590
Practice Address - Country:US
Practice Address - Phone:909-964-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95042465163WP0808X
CA95013934363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health