Provider Demographics
NPI:1477767671
Name:SAENZ, CARMEN ROSA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:SAENZ
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 1:16 SIMONTON CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1187
Mailing Address - Country:US
Mailing Address - Phone:561-358-3137
Mailing Address - Fax:888-710-4087
Practice Address - Street 1:16 SIMONTON CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1187
Practice Address - Country:US
Practice Address - Phone:561-358-3137
Practice Address - Fax:888-710-4087
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL012730400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL222Q00000XMedicaid
FL012730400Medicaid