Provider Demographics
NPI:1598537649
Name:SAUCEDO, SARA JESSE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JESSE
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 1:317 CAJON ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5963
Mailing Address - Country:US
Mailing Address - Phone:760-217-7870
Mailing Address - Fax:
Practice Address - Street 1:317 CAJON ST APT 7
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5963
Practice Address - Country:US
Practice Address - Phone:760-217-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker