Healthcare Provider Details

I. General information

NPI: 1982219994
Provider Name (Legal Business Name): JEANETTE ABIGAIL SAUCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 THIRD AVE
CHULA VISTA CA
91911-3202
US

IV. Provider business mailing address

9203 HARNESS ST
SPRING VALLEY CA
91977-4211
US

V. Phone/Fax

Practice location:
  • Phone: 619-796-8950
  • Fax:
Mailing address:
  • Phone: 619-796-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number59879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: