Provider Demographics
NPI:1124361969
Name:SALDANA, ENRIQUE MARIO
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:MARIO
Last Name:SALDANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 BOB BULLOCK LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-9771
Mailing Address - Country:US
Mailing Address - Phone:956-764-5050
Mailing Address - Fax:956-764-5081
Practice Address - Street 1:1911 BOB BULLOCK LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-9771
Practice Address - Country:US
Practice Address - Phone:956-764-5050
Practice Address - Fax:956-764-5081
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist