Healthcare Provider Details

I. General information

NPI: 1164837191
Provider Name (Legal Business Name): UZIEL SAUCEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555
US

IV. Provider business mailing address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-5610
  • Fax:
Mailing address:
  • Phone: 951-486-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA139156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: