Provider Demographics
NPI:1619072774
Name:SACA, RICARDO E (MD)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:E
Last Name:SACA
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 1:5343 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4252
Mailing Address - Country:US
Mailing Address - Phone:909-465-2077
Mailing Address - Fax:909-627-8106
Practice Address - Street 1:5343 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4252
Practice Address - Country:US
Practice Address - Phone:909-465-2077
Practice Address - Fax:909-627-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG642340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642341Medicaid
CAE69385Medicare UPIN
CA00G642340Medicare PIN