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General NPI Number Information
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NPI Number | 1972548428
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Entity Type | Individual
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Provider Name | ISAGANI L. SACULO CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 4315 28TH ST SUITE 2 SUITE 1C282
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City | LUBBOCK
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State | TX
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Zip | 79410-2507
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Country | US
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Telephone | 806-792-2104
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Fax |
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Provider Business Mailing Address
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Address Line | 1503 LANCELOT AVENUE
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City | WOLFFORTH
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State | TX
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Zip | 79382-3200
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Country | US
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Telephone | 903-452-3558
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Fax | 806-745-2337
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP114739
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License Number State | TX
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