Healthcare Provider Details

I. General information

NPI: 1245420959
Provider Name (Legal Business Name): MATTHEW MICHAEL SAUCEDA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

4642 CAMPUS AVE
SAN DIEGO CA
92116-1169
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8400
  • Fax:
Mailing address:
  • Phone: 619-318-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH52671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: