Healthcare Provider Details

I. General information

NPI: 1356713267
Provider Name (Legal Business Name): GILBERT SAENZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4622 MILDRED BASS ROAD
ST. CLOUD FL
34772
US

IV. Provider business mailing address

4622 MILDRED BASS ROAD
ST. CLOUD FL
34772
US

V. Phone/Fax

Practice location:
  • Phone: 407-973-1624
  • Fax:
Mailing address:
  • Phone: 407-973-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: