Healthcare Provider Details

I. General information

NPI: 1669960068
Provider Name (Legal Business Name): TRACEY SAUCIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6342 FALLBROOK AVE STE 102
WOODLAND HILLS CA
91367-1613
US

IV. Provider business mailing address

6342 FALLBROOK AVE STE 102
WOODLAND HILLS CA
91367-1613
US

V. Phone/Fax

Practice location:
  • Phone: 818-719-0055
  • Fax: 818-592-0904
Mailing address:
  • Phone: 818-719-0055
  • Fax: 818-592-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHP00065025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: