Provider Demographics
NPI:1760767156
Name:SAUCEDO, MIGUEL ANGEL (FNP)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 JACAMAN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2700
Mailing Address - Country:US
Mailing Address - Phone:956-615-0266
Mailing Address - Fax:956-615-0140
Practice Address - Street 1:2412 JACAMAN RD STE 105
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2700
Practice Address - Country:US
Practice Address - Phone:956-615-0266
Practice Address - Fax:956-615-0140
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119021363L00000X
TX696959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner