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NPI Code Detail

MEDICARE: JOSE SAUCEDO

MEDICARE: JOSE SAUCEDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor040851CA

General Provider Information

NPI Number : 1811016868
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE SAUCEDO
Provider Business Mailing Address
First Line : 216 S CONCORD ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-3020
Country : US
Telephone Number : 323-262-1786
Fax Number : 323-262-2659
Provider Business Practice Location Address
First Line : 2180 VALLEY BLVD
Second Line :
City : POMONA
State : CA
Zip : 91768-3325
Country : US
Telephone Number : 909-865-2336
Fax Number : 909-865-1831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/09/2019

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Directions to “ JOSE SAUCEDO ” Practice Location

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