Healthcare Provider Details

I. General information

NPI: 1861478877
Provider Name (Legal Business Name): CYNTHIA D. SACLOLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 476 BOX 25 NBHC SASEBO JAPAN
FPO AP CA
96322
US

IV. Provider business mailing address

USNH YOKOSUKA JAPAN PSC 475 BOX 1
FPO AP
96322
JP

V. Phone/Fax

Practice location:
  • Phone: 11-819-5650
  • Fax:
Mailing address:
  • Phone: 01181468168650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number550283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: