Healthcare Provider Details

I. General information

NPI: 1013282912
Provider Name (Legal Business Name): CARLOS LESLIE SAENZ PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29315 CENTRAL AVE
LAKE ELSINORE CA
92532-2212
US

IV. Provider business mailing address

29315 CENTRAL AVE
LAKE ELSINORE CA
92532-2212
US

V. Phone/Fax

Practice location:
  • Phone: 951-253-6039
  • Fax:
Mailing address:
  • Phone: 951-253-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 25780
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number05078
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: