Provider Demographics
NPI:1700372646
Name:SAUCEDO, CARLOS ANDRES
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANDRES
Last Name:SAUCEDO
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 1:4000 NW 51ST ST APT J174
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4353
Mailing Address - Country:US
Mailing Address - Phone:786-366-2723
Mailing Address - Fax:
Practice Address - Street 1:4000 NW 51ST ST APT J174
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4353
Practice Address - Country:US
Practice Address - Phone:786-366-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist