MEDICARE: CARLOS FERNANDO SAUCEDO PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY7298	CA

General Provider Information

NPI Number	:	1811982267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS FERNANDO SAUCEDO PH D

Provider Business Mailing Address
First Line	:	11260 WILBUR AVE
Second Line	:	SUITE 303
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2450
Country	:	US
Telephone Number	:	818-362-5454
Fax Number	:	818-362-1722

Provider Business Practice Location Address
First Line	:	11260 WILBUR AVE
Second Line	:	SUITE 303
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2450
Country	:	US
Telephone Number	:	818-362-5454
Fax Number	:	818-362-1722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	08/03/2011

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