Provider Demographics
NPI:1063043149
Name:SAUCEDO, DOLORES MARIE
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:MARIE
Last Name:SAUCEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 STOCKDALE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2664
Mailing Address - Country:US
Mailing Address - Phone:661-473-1500
Mailing Address - Fax:
Practice Address - Street 1:5121 STOCKDALE HWY STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2664
Practice Address - Country:US
Practice Address - Phone:661-473-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAMPSS-BQEWAC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No174400000XOther Service ProvidersSpecialist