Healthcare Provider Details

I. General information

NPI: 1316137466
Provider Name (Legal Business Name): JANIS JEAN SAUCEDA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 ROMA AVE NE
ALBUQUERQUE NM
87108-1334
US

IV. Provider business mailing address

1656 BOSQUE VISTA LOOP NW
LOS LUNAS NM
87031-8322
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2311
  • Fax:
Mailing address:
  • Phone: 505-565-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: