Healthcare Provider Details

I. General information

NPI: 1457830283
Provider Name (Legal Business Name): MATTHEW LEE SAENZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 BUSINESS DR STE 110
SACRAMENTO CA
95820-2233
US

IV. Provider business mailing address

3671 BUSINESS DR STE 110
SACRAMENTO CA
95820-2233
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8396
  • Fax:
Mailing address:
  • Phone: 916-734-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: