Healthcare Provider Details

I. General information

NPI: 1013033828
Provider Name (Legal Business Name): MR. IGNACIO SAUCEDO RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

650 N STATE ST
HEMET CA
92543-2960
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3300
  • Fax: 951-791-3333
Mailing address:
  • Phone: 951-791-3300
  • Fax: 951-791-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: