Healthcare Provider Details

I. General information

NPI: 1063432078
Provider Name (Legal Business Name): ADRIAN SAENZ PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 S US 301 STE B
SUMTERVILLE FL
33585-5355
US

IV. Provider business mailing address

6531 NW MELODY CT
PARKVILLE MO
64152-3374
US

V. Phone/Fax

Practice location:
  • Phone: 352-569-4980
  • Fax: 352-569-4981
Mailing address:
  • Phone: 863-414-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102774
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA9102774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: