Healthcare Provider Details

I. General information

NPI: 1669864559
Provider Name (Legal Business Name): ANTHONY FELAN SAENZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SAINT JOHN ST FL 1
HAVRE DE GRACE MD
21078-2817
US

IV. Provider business mailing address

330 SAINT JOHN ST FL 1
HAVRE DE GRACE MD
21078-2817
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-4158
  • Fax:
Mailing address:
  • Phone: 443-739-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM04645
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02181
License Number StateMD

VIII. Authorized Official

Name: MR. ANTHONY FELAN SAENZ
Title or Position: ACUPUNTURIST
Credential: LAC
Phone: 443-739-4158