Healthcare Provider Details

I. General information

NPI: 1669912804
Provider Name (Legal Business Name): SAUCEDO FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 2ND ST STE A
EAGLE PASS TX
78852-4118
US

IV. Provider business mailing address

2423 2ND ST STE A
EAGLE PASS TX
78852-4118
US

V. Phone/Fax

Practice location:
  • Phone: 830-335-2552
  • Fax: 830-335-2580
Mailing address:
  • Phone: 830-335-2552
  • Fax: 830-335-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberJ2303
License Number StateTX

VIII. Authorized Official

Name: JUAN SAUCEDO
Title or Position: OWNER
Credential: D.O.
Phone: 830-335-2552