Provider Demographics
NPI:1174644942
Name:SAUCEDO, ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
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 1:2811 WILSHIRE BLVD STE 810
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4812
Mailing Address - Country:US
Mailing Address - Phone:310-829-9788
Mailing Address - Fax:310-453-1576
Practice Address - Street 1:2811 WILSHIRE BLVD STE 810
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4812
Practice Address - Country:US
Practice Address - Phone:310-829-9788
Practice Address - Fax:310-453-1576
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG397342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G397340OtherBLUE SHIELD OF CA
CA00A418760Medicaid
CA00G397340OtherBLUE SHIELD OF CA
CAA86607Medicare UPIN