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General NPI Number Information
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NPI Number | 1962064881
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Entity Type | Individual
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Provider Name | JUAN RICARDO SAUCEDO FNP
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Gender | Male
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 2121 E GRIFFIN PKWY STE 12
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City | MISSION
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State | TX
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Zip | 78572-3072
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Country | US
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Telephone | 956-271-6203
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Fax | 956-529-5009
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Provider Business Mailing Address
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Address Line | 1704 SEBASTIAN ST
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City | MISSION
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State | TX
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Zip | 78572-6066
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Country | US
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Telephone | 830-513-2230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP142042
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP142042
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License Number State | TX
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