Healthcare Provider Details

I. General information

NPI: 1598091597
Provider Name (Legal Business Name): JOSE AGUSTIN SATURNO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE OBREGON 38 D
NOGALES SONORA
84030
MX

IV. Provider business mailing address

1299 CALLE TUBUTAMA
RIO RICO AZ
85648
US

V. Phone/Fax

Practice location:
  • Phone: 631-312-5117
  • Fax: 631-312-5117
Mailing address:
  • Phone: 520-245-7016
  • Fax: 520-761-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2651020
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: