Provider Demographics
NPI:1073782512
Name:SAUCEDO, MARCO BAILON (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:BAILON
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 N CARONDELET DR
Mailing Address - Street 2:
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:
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
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104513Medicare PIN
AZH48047Medicare UPIN