Provider Demographics
NPI:1003806787
Name:MARCO BAILON SAUCEDO MD PC
Entity Type:Organization
Organization Name:MARCO BAILON SAUCEDO MD PC
Other - Org Name:WOMEN'S HEALTH AND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-287-2257
Mailing Address - Street 1:490 N CARONDELET DR
Mailing Address - Street 2:WOMENS HEALTH & SURGERY CEN
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2453
Mailing Address - Country:US
Mailing Address - Phone:520-287-2257
Mailing Address - Fax:520-287-2259
Practice Address - Street 1:490 N CARONDELET DR
Practice Address - Street 2:WOMENS HEALTH & SURGERY CEN
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2453
Practice Address - Country:US
Practice Address - Phone:520-287-2257
Practice Address - Fax:520-287-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ27068207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH48047Medicare UPIN
AZZ104514Medicare PIN