Healthcare Provider Details

I. General information

NPI: 1871110965
Provider Name (Legal Business Name): GENARO SAUCEDA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 F ST
FRESNO CA
93706-3409
US

IV. Provider business mailing address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-6988
  • Fax:
Mailing address:
  • Phone: 559-255-8395
  • Fax: 559-255-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: