Provider Demographics
NPI:1710284211
Name:SAUCEDO, ENRIQUE III (IDMT)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:SAUCEDO
Suffix:III
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 MANOR CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2750
Mailing Address - Country:US
Mailing Address - Phone:210-592-6610
Mailing Address - Fax:
Practice Address - Street 1:10515 MANOR CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2750
Practice Address - Country:US
Practice Address - Phone:210-592-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians