Healthcare Provider Details

I. General information

NPI: 1669564985
Provider Name (Legal Business Name): REBECCA ANNETTE SAUCEDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 BUHNE STREET
EUREKA CA
95501
US

IV. Provider business mailing address

670 NINTH STREET SUITE 203
ARCATA CA
95521
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-1624
  • Fax: 707-441-1253
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP6179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: