Healthcare Provider Details

I. General information

NPI: 1053060012
Provider Name (Legal Business Name): JASMYN CUC-SAENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 HAZARD AVE
ENFIELD CT
06082-4592
US

IV. Provider business mailing address

2 WATERSIDE XING STE 401
WINDSOR CT
06095-1588
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-5020
  • Fax: 860-731-5536
Mailing address:
  • Phone: 860-731-5522
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181614
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: