Healthcare Provider Details

I. General information

NPI: 1669118816
Provider Name (Legal Business Name): PEDRO JUAN SAENZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E LA DIOSA DR
TEMPE AZ
85282-2159
US

IV. Provider business mailing address

14 E LA DIOSA DR
TEMPE AZ
85282-2159
US

V. Phone/Fax

Practice location:
  • Phone: 602-349-8932
  • Fax:
Mailing address:
  • Phone: 602-349-8932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-23899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: